Diseases of the Endocrine System Flashcards
(150 cards)
1
Q
In what age range do 90% of type 1 diabetics present?
A
<25
2
Q
What gene group is associated with familial risk of type 1 diabetes?
A
HLA
3
Q
What genetic disease has 20% of its patients also develop T1DM
A
Cystic fibrosis
4
Q
Which cells in the pancreas produce insulin/are destroyed in T!DM
A
Beta cells
5
Q
What is Kussmaul breathing?
A
Deep laboured breathing (hyperventilation) due to excessive ketones in the blood
6
Q
An acute injury to which organ can cause hypoglycaemia in T1 diabetics
A
AKI
7
Q
At what blood glucose do the neuroglycopenic symptoms of hypoglycaemia occur?
A
<2mmo/L
8
Q
What is the treatment for hypoglycaemia if the patient can swallow?
A
- 60ml Glucojuice OR
- 4-5 Glucotabs OR
- 150-200mls pure fruit juice (but not in renal failure)
9
Q
What is the treatment for hypoglycaemia if the patient is drowsy or confused?
A
1.5-2 tubes of glucose gel (use patients own finger to rub it into the gums)
10
Q
What is the treatment for hypoglycaemia if the patient is
A
IV glucose – infused over 10-15 minutes. Either 75ml of 20% glucose or 150ml of 10% glucose
+
20g of complex carb after 15 minutes if they’re better
11
Q
What are the three criteria for DKA?
A
Ketones in the blood (or urine) + acidosis + hyperglycaemia (usually)
12
Q
In DKA, which of the following can be raised and which can be reduced?
- Potassium
- Creatinine
- Sodium
- Lactate
- Amylase
- WCC
A
- Potassium usually raised due to lack of insulin but can be low normal
- Creatinine often raised
- Sodium often reduced
- Lactate often raised
- Amylase frequently raised (this doesn’t always mean pancreatitis, can be salivary in origin)
- White cell count can be raised
13
Q
What is the treatment of DKA?
A
Insulin diluted with sodium chloride 0.9%
+ fluid replacement with sodium chloride (glucose falls to about 15, use dextrose as well)
+ Potassium chloride
14
Q
How much folic acid should diabetic pregnant women take?
A
5mg
15
Q
What is lipohypertrophy in T1DM?
A
Swelling at injection site in patients who constantly inject into the same place
16
Q
What is the normal target HbA1c?
A
< 48 mmol/L
17
Q
What range is considered diabetic on:
- A fasting glucose
- 2hr OGTT
A
Fasting = ≥ 7.0 mmol/L
OGTT = ≥11.1 mmol/L
18
Q
What range is considered pre-diabetic on:
- A fasting glucose
- 2hr OGTT
A
Fasting = 6.1-6.9 mmol/L
OGTT = 7.8-11.0 mmol/L
19
Q
What is the normal target glucose range for a T1 diabetic adult?
A
4–7mmol/L
20
Q
What is the normal target glucose range for a T1 diabetic adult 90 minutes after meals?
A
5–9mmol/L
21
Q
What types of insulin are Humalog, Novarapid and apidra?
A
Rapid acting - works immediately, peaks at 2 hrs and has a duration of around 4 hrs
22
Q
What types of insulin are Humulin S, actrapid and insuman rapid?
A
Soluble insulin -peaks at around 4 hrs and has a duration of around 8. They take 30 mins to take effect so must be taken 30 minutes before eating
23
Q
What types of insulin are insulatard, Humulin I and insuman basal?
A
Intermediate acting - duration of action of about 16 hours
24
Q
What types of insulin are lantus and levemir?
A
Long acting analogues - duration of about 24 hours
25
What types of insulin are Humulog Mix25 / mix50, novomix30, Humulin M3, Insuman comb 12?
Fixed mix insulin
26
What % increase in insulin is advised if blood glucose is high?
10%
27
1 unit of insulin is needed per ____g of carbs
10
28
What equipment is used to test for peripheral neuropathy in a diabetic foot exam?
10g monofilament & 128 Hz tuning fork
29
What is Charcot foot?
A rare but serious complication of diabetes following from severe neuropathy. Bone density is reduced → joints are destroyed → gross deformity → bag of bones on x-ray
30
What reproductive issue happen to 50% of male diabetics?
Erectile dysfunction
31
What are the three criteria for hyperglycaemic hyperosmolar syndrome?
Hypovolaemia
+ hyperglycaemia
+ hyperosmolar
(without significant acidosis or ketonemia)
32
Name the main risk factors for hyperglycaemic hyperosmolar syndrome
* Type 2 diabetes
* High refined carb intake pre-event
* Older individuals
* Younger individuals in non-Caucasians
* CVD events, sepsis
* Medications eg glucocorticoids and thiazides
33
Metaformin hydrochloride is an example of what class of drug?
Biguanides
34
Tolbutamide, chlorpropamide, glibenclamide & gliclazide are examples of what class of drugs?
Sulphonylureas
35
Dapagliflozin is an example of what class of drug?
Sodium Glucose Lactate 2 Inhibitor
36
What is the worrying side effect of metformin to watch out for?
Lactic acidosis
37
Which diabetic medication is most likely to cause hypos?
Sulphonylureas
38
What main side effects are associated with SGL2 inhibitors?
Thrush/UTIs
39
What hormone is associated with diabetes insipidus?
ADH
40
What is the difference between cranial and nephrogenic diabetes insipidus?
Cranial - ADH deficiency originating in the posterior pituitary. Can be treated by replacing ADH
Nephrogenic - renal resistance to ADH. Untreatable
41
What results on a urine osmolarity and fluid deprivation tests would you expect to see in a person with diabeties insipidus?
Urine osmolarity - dilute urine
Fluid deprivation test - fluid output does not decrease and urine osmolarity does not go up
42
What are the three components of metabolic syndrome?
Obesity, diabetes, high blood pressure
43
How do you tell on examination if a lump in the neck is attached to the thyroid or not?
Thyroid moves up on swallowing. Anything attached to it will move up also.
44
Name the main causes of hyperthyroidism
- Grave's disease (autoimmune)
- Toxic multinodular goitre
- Adenoma and carcinoma
- De Quervain’s Thyroiditis (temporary hyperthyroidism)
45
Describe the changes to T3/4 and TSH in hyperthyroidism
Free T3/4 high. TSH low
46
What is the serious complication of hyperthyroidism?
Thyroid storm
47
What are the most common triggers of thyroid storm?
- Illness/infection
| - Surgery
48
What antibodies are associated with Grave's disease?
- Anti-TPO antibody
- TSH receptor antibody
- Anti-thyroglobulin antibody
49
What two drugs are the most common treatments for hyperthyroidism?
Carbimazole and propylthiouracil
50
Which hyperthyroidism drug cannot be used during the 1st trimester of pregnancy?
Carbimazole
51
What is the most significant risk of carbimazole?
Agranulocytosis
52
What 2 treatments are also considered in hyperthyroid beside medication?
- Radio-iodine
| - Surgery
53
Does Graves disease present with a goitre?
Usually not
54
What auto-antibody (immunoglobulin) stimulates the release of thyroid hormones in Graves?
IgG
55
What is the condition of bulging eyes in Grave's disease called?
Exophthalmos/proptosis
56
What lifestyle factor is exophthalmos strongly associated with?
Smoking
57
What is pretibial myxoedema and in what disease is it found??
Bilateral plaque formation on the anterior surface aspect of the lower legs in Grave's disease. ‘Orange peel’ appearance and non-pitting
58
What bone condition is associates with Graves disease?
Osteoporosis
59
What is the most common cause of hyperthyroidism?
Graves disease
60
What is the second most common cause of hyperthyroidism?
Nodular thyroid disease/Toxic Multinodular Goitre (TMG)
61
How do you tell nodular thyroid disease/toxic multinodular goitre from Graves disease?
TMG is antibody negative
62
What causes De Quervain’s thyroiditis?
Acute inflammatory process - usually viral
63
Describe the progress of De Quervain’s thyroiditis
Viral infection → thyrotoxicosis/hyperthyroidism for a few weeks → hypothyroidism for a few weeks → euthyroid
64
What arrhythmia drug can cause both hyper- and hypothyroidism
Amioderone
65
What arrhythmia is most commonly associated with hyperthyroidism?
AF
66
What are the main causes of hypothyroidism?
- Hashimoto’s thyroiditis
- Iodine deficiency
- Drug-induced
- Secondary causes (eg loss of function of hypothalamus/pituitary)
67
What is the most common cause of hypothyroidism in the UK?
Hashimoto’s thyroiditis
68
What is the severe complication of hypothyroidism?
Myxoedema coma
69
Who is most at risk of myxoedema coma
Elderly women with long standing but frequently unrecognized or untreated hypothyroidism
70
Describe the changes to T3/4 and TSH in hypothyroidism
Decreased T4/3. Increased TSH
71
What is the main antibody associated with Hashimoto's?
Anti-TPO antibody positive
72
What drug is used to treat hypothyroidism?
Levothyroxine
73
What is the most common cancer of the thyroid gland
Papillary
74
What cancer is associated with autoimmune hypothyroidism?
Thyroid lymphoma
75
What rare thyroid cancer secretes calcitonin?
Medullary thyroid cancer
76
Apart from idiopathic, what is the other main cause of idiopathic thyroid cancer?
Radiation
77
Who is most at risk of thyroid cancer?
Women >15 (most common >40)
78
Accidentally removing what is a risk of thyroid surgery?
Parathyroid glands - causing hypocalaemia
79
Out of papillary and follicular thyroid cancers, which mostly spreads via lymphatics and which via haemtological spread
```
Papillary = lymphatics
Follicular = haematological
```
80
What changes is TFTs are often seen in generally unwell patients in hospital?
TSH typically suppressed (sick euthyroid syndrome)
81
What type of thyroid lump classically moves upwards when the tongue is stuck out?
Thyroid cyst
82
What is the most common change in thyroid hormones during pregnancy?
14% see increased fT4
83
What is the function of aldosterone?
Retention of sodium and loss of potassium
84
What is Conn's syndrome?
Aldosterone secreting tumour (usually ademona) in the zona glomerulosa causing primary aldosteronism
85
What cardiac condition is caused by primary aldosteronism (Conn's/adrenal hyperplasia)?
Secondary hyperplasia
86
What tests are used to diagnose Conns/primary aldosteronism?
```
Aldosterone to renin ration
+
Saline suppression test (aldesterone cannot be fully suppressed in Conn's)
+
CT
```
87
What are some non-congenital causes of adrenal hyperplasia (causing primary aldosteronism + secondary hypertension)
- Endogenous ACTH production (eg Cushing’s disease)
| - Ectopic ACTH production (eg small cell lung carcinoma)
88
Congenital adrenal hyperplasia is a cause of secondary _____
Hypogonadism
89
What hormone is in excess in Cushing's
Cortisol
90
If Cushing's is caused by hypersecretion of ACTH, what else apart from glucocorticoids will be stimulated?
DHEA/sex hormones- produces testosterone and related symptoms (acne/amenorrhoea etc)
91
What is the best test for Cushings?
High dose dexamethasone test
92
What is Cushing's disease?
ACTH secreting pituitary adenoma
93
What ectopic cancers most commonly cause high circulating levels of ACTH
Lung, thymus and pancreas
94
What are ACTH independent causes of Cushing's?
```
Hypersecretion of cortisol can be caused by:
• Adrenal adenoma
• Adrenal carcinoma
• Nodular hyperplasia
• High dose steroid use
```
95
A high dose dexamethasone test shows ACTH levels of <300 and high dose dexamethasone suppression of 50%. What is the cause of the Cushings?
Cushing's disease (ACTH secreting pituitary adenoma)
96
A high dose dexamethasone test shows ACTH levels of >300 and high dose dexamethasone suppression of 0%. What is the cause of the Cushings?
Ectopic cause (likely cancer)
97
A high dose dexamethasone test shows ACTH levels of <1 and high dose dexamethasone suppression of 0%. What is the cause of the Cushings?
Adrenal cause (eg adrenal adenoma/high dose steroids etc)
98
What hormones are not produced in Addison's disease?
Glucocorticoids and mineralocorticoids
| aka steroid hormones
99
What is the potentially fatal complication of Addison's and what can trigger it?
Adrenal crisis - triggered by stress, infection, traum& surgery
100
What is the best test for Addison's?
Synacthen test (ACTH stimulating test) - poor rise in cortisol indicates Addison's
101
What drugs are given as a treatment for Addison's?
Hydrocortisone and fludrocortisone
102
What are the sick day rules for people with Addison's?
MUST double up on their medication
103
What is a pheochromocytoma?
Neuroendocrine tumour of the medulla of the adrenal glands secreting catecholamines (adrenaline and noradrenaline)
104
What genetic condition is associated with bilateral pheochromocytoma?
MEN2
105
What is the triad of symptoms associated with pheochromocytoma?
- Hypertension (50% paroxysmal)
- Sweating
- Headaches
106
What is the first-line specific investigations into pheochromocytoma?
Urinary catecholamines and metabolites
107
Coming off which class of drugs can cause secondary adrenal insufficiency?
High dose steroids - causes ACTH surpression
108
Excessive use of high dose steroids can cause iatrogenic _____?
Cushing's
109
Secondary adrenal insufficiency causes the same symptoms as Addison’s (primary adrenal insufficency) EXCEPT what?
Increased tanning/skin darkening - due to secondary causing no increase in ACTH
110
MEN1 and MEN2 are associated with tumors of which body system?
Endocrine
111
What 3 major endocrine issues are associated with MEN1
Pituitary adenomas, parathyroid hyperplasia (hyperparathyroidism) and pancreatic tumours
112
What major endocrine tumours are associated with MEN2
Medullary thyroid cancer, parathyroid tumors, and pheochromocytoma
113
Von Hippel-Lindau (VHL) is mainly associated with tumours of which body systems?
Vascular (eg haemangiomas) and endocrine (eg pheochromocytomas)
114
Pheochromocytomas can be associated with a genetic condition that also causes axillary freckling and Café-au-lait patches. What condition is this?
Neurofibromatosis type 1
115
What is the main hormone raised is acromegaly?
Insulin growth factor 1 (IGF-1)
116
What is the definitive test for acromegaly?
Oral glucose tolerance test - growth hormone will no be suppressed
117
What medications can be used for acromegaly?
Dopamine agonists OR somatostatin receptor agonists OR growth hormone antagonists
118
What genetic condition is associated with pituitary tumours?
MEN1
119
What is the most common type of functional pituitary tumour?
Prolactinoma
120
Does a hyperprolactinaemia cause menorrhagia or amenorrhoea
Amenorrhoea (or period irregularity)
121
What hormones are secreted by the anterior pituitary
- Growth hormone (GH)
- Adrenocorticotrophic hormone (ACTH)
- Thyroid stimulating hormone (TSH)
- Prolactin
- Follicle stimulating hormone
- Luteinising hormone (LH)
122
What hormones are secreted by the posterior pituitary
- Oxytocin
| - Anti-diuretic hormone (ADH)
123
What drugs are used in prolactinomas?
Dopamine agonists
124
What is the most common cause of hypercalcaemia?
Parathyroid adenoma causing primary hyperparathyroidism
125
What does groans, moans, bones and stones mean?
GROANS (constipation), MOANS (depression and fatigue), BONES (sore bones) AND (kidney) STONES
126
What will usually happen to the phosphate levels in hypercalcaemia caused by the parathyroid glands vs hypercalcaemia caused by bony pathology?
Parathyroid glands = low/normal
| Bony pathology = raised
127
In Familial Hypocalciuric Hypocalcaemia the blood calcium is high and the urine calcium is____
Low
128
Chronic disease of what organ causes secondary hyperparathyroidism?
Chronic renal disease - parathyroid glands become enlarged and release too much PTH because kidneys cannot make active vitamin D (needed to absorb calcium)
129
Hyperparathyroidism causes hypercalcaemia + _____
Osteoporosis
130
In hypoparthyroidism there is hypocalcaemia and hyper_______
Hyperphosphatemia
131
Pseudohypoparathyroidism is resistance to _____
Parathyroidism (PTH)
132
Lack of vitamin D decreases absorption of which two minerals?
Ca2+ and PO4 3-
133
What is the difference in PTH between hypoparathyroidism and vitamin D deficiency
Hypoparathyroidism = low PTH
Vitamin D deficiency = high PTH
134
Do osteoblasts build or break down bone?
Build
135
Alendronate, risedronate and etidronat are examples of what class of drug?
Bisphosphonates
136
Primary amenorrhea is defined as _____
Failure of menarche by the age of 16 years
137
Secondary amenorrhea is defined as______
Cessation of periods for >6 months in an individual who has previously menstruated
138
To be diagnosed with PCOS a patient must have 2 of what 3 symptoms?
- Oligomenorrhoea/amenorrhoea
- Hyperandrogenism
- Polycystic ovaries on ultrasound
139
What fertility drug is used in PCOS
Clomiphene citrate
140
Premature ovarian failure is menopause before what age?
40
141
Klinefelter’s syndrome (causes primary hypogonadism) is what karytope?
47 XXY
142
Turner syndrome ( can cause premature ovarian failure) is what karytope?
XO
143
What is SIADH?
Syndrome of inappropriate antidiuretic hormone secretion (causes Low sodium, low sodium and low serum osmolarity while euvolemic)
144
What are the 2 common causes of hypernatraemia - increased water loss/decreased water intake OR increased sodium loss/decreased sodium intake
Increased water loss (eg diabetes insipidus) or decreased water intake (eg dehydration)
145
What is the most common cause of hyponatremia?
Decreased water excretion/water retention (eg SIADH)
146
What is the first sign of of hyperkalaemia on an ECG?
Peaked T waves
147
What is the treatment for hyperkalaemia?
```
10mls 10% calcium gluconate
+
Actrapid 10units ) with 50mls 50% dextrose
+
Salbutamol Nebs
```
148
Lactic acidosis does what to the anion gap?
Raises it
149
Is there ketonaemia in lactic acidosis?
No
150
What happens to bicarbonate in lactic acidosis
It's reduced
