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Endocrine Flashcards

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1
Q

What is Acromegaly?

A

Hormonal disorder resulting from too much Growth hormone release

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2
Q

What causes acromegaly?

A

Most common - benign pituitary adenoma

Other - small cell carcinoma, medication

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3
Q

what is the pathology of acromegaly?

A

Increased GH => increased glucose release, muscles retain nitrogen causing them to grow => epiphyseal plates fused so can only grow in places where there is still growth => jaw, nose, hands, feet

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4
Q

5 symptoms of acromegaly?

A 
Bigger hands, feet and face
excessive sweating 
tiredness
weight gain
headache 
deep voice/amenorrhoea
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5
Q

6 signs of acromegaly?

A 
Bi-temporal hemianopia 
spade like hands and feet 
large tongue - macroglossia
Jaw protrusion - prognathism 
interdental seperation
predominant forehead
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6
Q

what are 3 1st line investigations for acromegaly?

A

insulin like growth factor 1 - Raised
Random serum growth hormone - raised
MRI of pituitary gland

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7
Q

What is the gold standard test for acromegaly?

A

oral glucose tolerance test - raised

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8
Q

What are 3 differentials for acromegaly?

A

prolactinoma
marfan’s syndrome
precocious puberty

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9
Q

What is the management for acromegaly?

A

1st line - trans-sphenoidal surgery

2nd line - cabergoline (dopamine agonist) and somatostatin analogue (octreotide), radiotherapy, pegvisomant - GH antagonist give SC OD

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10
Q

What are 4 complications of acromegaly?

A

T2DM
Arthritis and carpal tunnel
Hypertension
Heart Failure

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11
Q

What is Addison’s disease?

A

a disorder affecting adrenal glands, causing decreased production of adrenocortical hormones (cortisol, aldosterone, and dehydroepiandrosterone)

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12
Q

what causes Addison’s disease?

A

Autoimmune - adrenal gland or 21-hydroxylase antibodies

Also - TB, infectious disease, secondary to HIV infections

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13
Q

What are 4 risk factors for Addison’s?

A

Female
adrenal hemorrhage
autoimmune diseases
HIV/TB

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14
Q

What is the pathophysiology for Addison’s?

A

there is decreased adrenocortical hormones due to either destruction of all 3 layers of the adrenal cortex (GFR) or disruption of hormone synthesis

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15
Q

What are 7 clinical presentations of Addison’s?

A 
Hyper pigmentation
Fatigue and weakness
Weight loss/anorexia
salt craving 
loss of pubic hair (women)
Hypotension and tachycardia
nausea/vomiting
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16
Q

What are 2 investigations for Addison’s?

A

serum electrolytes - low Na+, elevated K+

morning serum cortisol levels - low

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17
Q

what is the gold standard test for Addison’s?

A

Adrenocorticotrophic hormone stimulation test (synacthen’s test) - low

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18
Q

What are 3 differentials for Addison’s?

A

Adrenal suppression due to corticosteroid therapy
haemochromatosis
hyperthyroidism

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19
Q

What is the management for Addison’s?

A

Hydrocortisone

Fludrocortisone

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20
Q

what are 3 complications of Addison’s?

A

Secondary Cushing’s syndrome (too much glucocorticoid replacement)
osteopenia/porosis
treatment related hypertension

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21
Q

What is the prognosis for Addison’s?

A

Replacement therapy for life, non-adherence to treatment is life threatening (generally good adherence due to uncomfortable symptoms with non-adherence)

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22
Q

What is Cushing’s syndrome?

A

the clinical manifestation of pathological HYPERcortisolism

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23
Q

is Cushing’s more common in women or men?

A

women

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24
Q

what are 4 causes of Cushing’s?

A

exogenous corticosteroid exposure (most common)
ACTH secreting pituitary adenoma/carcinoma
adrenal cortisol secreting adenoma/carcinoma (rarer)
gene mutation

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25
What are 4 risk factors for Cushing's?
Exogenous corticosteroid use pituitary/adrenal adenoma adrenal carcinoma small cell lung cancer
26
What are 7 clinical manifestations of Cushing's?
``` facial redness + moon face hypertension stretch marks + acne menstrual irregularities osteoporosis/unexplained fractures weight gain/central obesity dorsocervical fat pad - buffalo hump ```
27
What are 3 investigations of Cushing's?
late night salivary cortisol - elevated overnight dexamethasone suppression test - elevated 24 hour urinary free cortisol - elevated
28
what is the gold standard test for Cushing's?
late night salivary cortisol - elevated
29
What is the management of Cushing's?
1st line - trans-sphenoidal pituitary adenectomy/ adrenalectomy adjuncts - post surgery corticosteroid/non-corticosteroid replacement, chemo, radiotherapy on primary tumour
30
is reoccurrence common with Cushing's?
Yes | untreated survival = 50%
31
what are 4 complications of Cushing's?
osteoporosis increased infection DM hypertension
32
What is DMT1?
a metabolic autoimmune disorder characterised by hyperglycaemia due to destruction of insulin producing beta cells in the pancreas, results in absolute insulin deficiency.
33
who is DMT1 most common in?
women + young people | 5-10% of all diabetes patients
34
what are 4 risk factors for DMT1?
geographic region - N Europe FHx Other autoimmune disease dietary factors
35
what causes DMT1?
autoimmune pancreatic beta cell destruction | subclinical until 80-90% of beta cells have been destroyed
36
What are 6 clinical manifestations of DMT1?
``` polyuria + polydipsia + hunger blurred vision fatigue/tiredness weight loss FHx of autoimmune disorders KETOACIDOSIS ```
37
what is the gold standard test for diabetes?
HbA1c > 48 mmol/mol
38
what are 4 tests for DMT1?
Random glucose tolerance test (>11.1mmol/L) Fasting plasma glucose - raised 2-hour plasma glucose - raised plasma or urine ketones - raised
39
What is the management of DMT1?
``` Basal-bolus insulin (insulin glargine s/c) Pre-meal insulin correction dose Amylin analogue (pramlintide) ``` 2nd line: fixed insulin dose.
40
What are 3 side effects of insulin?
hypoglycaemia weight gain lipodystrophy
41
What are the 3 microvascular complications of Diabetes?
retinopathy neuropathy nephropathy
42
what are 3 macrovascular complications of diabetes?
IHD cerebrovascular disease peripheral artery disease
43
what are the legal requirements of a person with DMT1?
inform DVLA of insulin use => may not be allowed to drive
44
what is DMT2?
A metabolic disorder of hyperglycaemia due to a combination of insulin resistance and deficiency
45
when is DMT2 common?
populations with affluent lifestyles older age male S asian, Afrocaribbean at greater risk
46
what causes DMT2?
Decreased insulin secretion and/or increased insulin resistance. Associated with obesity, lack of exercise, increase calorie intake and alcohol excess
47
What are 5 risk factors of DMT2?
``` Family history (genetics) increasing age obesity poor exercise ethnicity ```
48
what is the pathophysiology of DMT2?
post receptor resistance 50% of beta cell mass usually lost => greater amounts of insulin produced by fewer beta cells => hyperglycaemia and lipid excess are toxic to beta cells.
49
What are 8 clinical manifestations of DMT2?
``` polyuria, nocturia + polydypsia weight loss and fatigue ketonuria glycosuria acanthosis nigricans - black pigment on nape of neck and axillae visual blurring candida infections itchy vulva/swollen penis ```
50
what are 5 differentials for DMT2?
``` DMT1 Pancreatitis neoplasia of pancreas acromegaly Drugs (thiazide diuretics, beta-blockers, immunosuppressives, thyroid hormone) ```
51
What is the 1st line management of DMT2?
LIFESTYLE
52
what is the monitoring for DMT2?
daily glucose monitoring | annual diabetic review, foot checks
53
what are 6 complications of DMT2?
``` Staphylococcal skin infection retinopathy erectile dysfunction peripheral arterial disease CAD/IHD kidney disease ```
54
what are 3 contraindications to metformin prescription?
heart failure, liver disease, renal disease
55
What is diabetic ketoacidosis?
A life-threatening metabolic emergency due to lack of insulin and accumulation of ketones leading to acidosis
56
What kind of diabetic does diabetic ketoacidosis happen in?
most usually type I as type II often have enough underlying insulin to prevent ketoacidosis also typically in younger patients and new diabetics
57
what are some causes of diabetic ketoacidosis?
Underlying infection, disruption of insulin treatment, new onset of diabetes, binge drinking, illegal drugs, menstruation, pregnancy, medication (steroids)
58
what 6 risk factors for diabetic ketoacidosis?
``` Stopping insulin therapy infection surgery MI Pancreatitis undiagnosed diabetes ```
59
what is the pathology of diabetic ketoacidosis?
No insulin => lipolysis => Free Fatty acids => oxidised in liver => ketone bodies => ketoacidosis
60
what are 7 clinical presentations of diabetic ketoacidosis?
``` ketone smelling breath (pear drops) polydipsia + polyurea drowsiness, confusion, fainting and coma high blood glucose + ketones Kassmoul's respiration (deep fast breathing) vomiting blurred vision ```
61
What is the gold standard test for diabetic ketoacidosis?
raised plasma ketones - >3mmol/L
62
what is the blood glucose like in diabetic ketoacidosis?
raised blood glucose
63
what are 3 other tests for diabetic ketoacidosis?
ABG - pH ans HCO - low urine stick test - ketones FBC - raised WBC
64
what are 3 differentials for diabetic ketoacidosis?
hypoglycaemia - low ketones and blood glucose lactic acidosis hyperosmolar hyperglycaemic state - T2DM - high glucose, no/low ketones, high osmolar state, bicarbonate not lowered
65
What is Grave's disease?
An autoimmune thyroid condition associated with hyperthyroidism and over production of thyroid hormones
66
are thyroid disorders and cancers more common in men or women?
women
67
what causes Grave's disease?
thyroid hormone overproduction stimulated by TSH receptor antibodies can be genetic
68
What are 4 risk factors for Grave's disease?
FHx Autoimmune disease Stress High Iodine intake
69
What is the pathophysiology for Grave's disease?
TSH receptor autoantibodies cause thyroid hormone hyperproduction as well as thyroid hypertrophy and hyperplasia of thyroid follicular cells resulting in the clinical manifestations of hyperthyroidism and diffuse goiter.
70
What are 7 clinical presentations of Grave's disease?
Thyroid acropachy - clubbing Thyroid bruit Pretibial myxoedema Diffuse goitre Hyperthyroidism signs - heat intolerance, sweating, tremor oncholysis - separation of nail from finger menstrual irregularities/sexual dysfunction
71
What are the investigations for Grave's disease?
THYROID FUNCTION TESTS TSH suppressed, T3/4 high TSH receptor antibodies - present
72
what are 4 differential diagnoses for Grave's disease?
toxic nodular goitre post-natal thyroiditis TSH producing pituitary adenoma ingestion of thyroid hormone
73
What is the management of Grave's disease?
1st line - antithyroid therapy (carbimazole, thiamozole), thyroid surgery, radioactive iodine adjuncts - symptomatic therapy, therapy for orbitopathy, post op thyroid replacement
74
What is the treatment for diabetic ketoacidosis?
1st - imediate ABC management, 0.9% saline, insulin + glucose adjuncts - restore electrolyte loss
75
what are 4 complications of Grave's disease?
bone mineral loss AF/congestive heart failure sight threatening complications elephantiasis dermopathy
76
what is Hashimoto's thyroiditis?
an autoimmune-mediated lymphocytic inflammation of the thyroid gland resulting in a destructive thyroiditis with release of thyroid hormone causing transient hyperthyroidism (for 2/3 months) then permanent hypothyroidism
77
what are 3 risk factors for Hashimoto's thyroiditis?
Female Autoimmune disease genetics - Turner's/Down's
78
what antibodies cause Hashimoto's thyroiditis and what do they do?
Thyroid peroxidase antibodies attack thyroid cells causing fibrosis and the release of stored thyroid hormone causing transient hyperthyroidism for a few months before stores run out and permanent hypothyroidism ensues
79
What are 6 investigations to diagnose Hashimoto's thyroiditis?
TSH level - high in hyperphase then low serum free T3/4 - elevated in hyper, low in hypo thyroid peroxidase antibodies - present TSH receptor antibodies - negative radio iodine uptake - low total T3/4 ratio - high in hyper then low
80
what is the gold standard test for Hashimoto's thyroiditis?
Thyroid peroxidase antibodies test
81
what are 4 differentials for Hashimoto's?
Grave’s Disease toxic multinodular goitre Factitious ingestion of thyroid hormone Iodine-induced
82
what is the management of Hashimoto's?
levothyroxine
83
what are 3 complications of Hashimoto's?
Atrial fibrillation IHD/CHF low risk of developing Grave’s disease
84
what is the prognosis for Hashimoto's thyroiditis?
Permanent hypothyroidism and treatment with levothyroxine
85
What is defined as hyperkalaemia?
high potassium >6 mol/L | small potassium changes have significant muscular and cardiac effects
86
what causes hyperkalaemia?
high intake and decreased renal excretion | extracellular redistribution of potassium - decreased cell entry/increased cell exit of potassium
87
what are 4 risk factors for hyperkalaemia?
Renal failure diabetes adrenal insufficiencies drugs (ACEi, ARBs, Diuretics, NSAIDs)
88
what is the pathopysiology of hyperkalaemia?
``` decreased excretion of potassium due to acute/chronic renal insufficiency reduction in plasma aldosterone pseudo hypoaldosteroism congenital adrenal hyperplasia lupus ```
89
what 7 drugs can cause hyperkalaemia?
``` potassium sparing diuretics NSAIDs Trimethoprim/pentamidine ACEi/ARBs heparin calcineurin inhibitors - ciclosporin loop/thiazide type diuretics ```
90
what are the clinical manifestations of hyperkalaemia?
``` muscle weakness ECG changes ascending paralysis SOB chest pain, nausea and vomiting ```
91
what ECG changes are present in hyperkalaemia?
``` tall peaked (tented) T waves prolonged PR interval (>0.2s) loss of P wave widened QRS complex ST segment depression ```
92
What are the 4 investigations for hyperkalaemia?
Basic metabolic panel (serum potassium, glucose, bicarb, urea, and creatinine) serum calcium FBC ECG
93
what are 6 differential diagnoses for hyperkalaemia?
``` CKD/acute kidney failure diabetic ketoacidosis/HHS drug related hyperkalaemia potassium supplementation + underlying renal dysfunction renal tubular acidosis Addison’s disease ```
94
what is given in a hyperkalaemic emergency?
IV calcium gluconate/chloride insulin/glucose infusion nebulised salbutamol
95
what is a complication of hyperkalaemia?
life threatening arrhythmias
96
what is given in non-emergency hyperkalaemia?
patiruer and sodium ziconium cyclosilicate
97
What is Hyperosmolar Hyperglycaemic state?
a life threatening metabolic emergency characterised by marked hyperglycaemia, hyperosmolality and volume depletion in the absence of significant ketoacidosis
98
when is Hyperosmolar hyperglycaemic state likely to present?
in those in middle or later life with previously undiagnosed diabetes 1% of all diabetes hospital admissions
99
what can cause HHS?
relative insulin deficiency - infection, MI, stroke, acute illness/trauma rarer - endocrine disorders, non-adherence, corticosteroids, thiazide diuretics, beta blockers, didanosine
100
What are 4 risk factors for HHS?
Infection MI/Stroke Poor medication compliance Vomiting
101
what is the pathophysiology of HHS?
Endogenous insulin levels reduced, sufficient to inhibit hepatic ketogenesis but insufficient to inhibit hepatic glucose production => increasing hyperglycemia and tissue damage
102
what are 6 clinical manifestations for HHS?
``` Reduced GCS polyuria/oliguria + polydipsia dehydration weakness tachycardia and hypotension nausea + vomiting ```
103
what are the four 1st line investigations for HHS
glucose levels U+Es ABG Blood/urinary ketones
104
what is the gold standard test for HHS?
serum osmolality - raised
105
What are 4 differentials for HHS?
diabetic ketoacidosis lactic acidosis/alcoholic ketoacidosis paracetamol overdose ingestion of toxic substances
106
what is the management for HHS?
1st line - fluid replacement (0.9% saline), potassium replacement if low adjuncts - LMWH, restore electrolyte loss, insulin
107
what are 4 complications of HHS?
AKI MI stroke/seizure
108
what is the mortality for HHS?
5-15%
109
what are 5 causes of hyperthyroidism?
``` Grave's disease (most common) Plummer's disease Thyroiditis thyroid cancer subacute thyroiditis (granulomatous or De Quervain's) ```
110
what are 8 risk factors for hyperthyroidism?
``` female post-partum 60+ FHx autoimmune diseases radiation lithium therapy smoking ```
111
What are 5 symptoms of hyperthyroidism?
``` Heat intolerance/sweating palpitations/tremor irritability menstrual irregularities/sexual dysfunction Goitre ```
112
what are 5 signs of hyperthyroidism?
``` orbitopathy (Grave's) cardiac flow murmor scalp hair loss acropachy (Grave's) weight loss ```
113
what is the gold standard investigation for hyperthyroidism?
serum free total T3/4
114
what are 3 investigations for hyperthyroidism?
TSH - high/low TSH receptor antibodies - may be present Serum free/total T3/T4 - high
115
what are 2 differentials for hyperthyroidism?
TSH producing pituitary adenoma | thyroid hormone resistance
116
what is the 1st line management of hyperthyroidism?
antithyroid therapy thyroidectomy (+ post-op thyroid replacement) radioactive iodine corticosteroid
117
what are 3 complications of hyperthyroidism and its management?
hypothyroidism congestive heart failure bone mineral loss
118
what is hypokalaemia?
serum potassium <3.5 mol/L
119
what can cause hypokalaemia?
GI losses - D+V, malabsorption, oral sodium phosphate solution decreased intake increased potassium entry into cells (increased pH, insulin etc) increased potassium excretion (GI, burns, sweat) Dialysis
120
what are 5 clinical manifestations of hypokalaemia?
``` muscle weakness, cramps and pain ECG changes and cardiac arrhythmia rhabdomyolysis renal abnormalities psychological symptoms ```
121
what ECG changes are seen in hypokalaemia?
U waves flattening and inversion of T waves (mild) Q-T interval prolongation mild ST depression (severe)
122
what are 4 investigations in hypokalaemia?
basic metabolic panel ECG U+E + creatinine levels urine electrolytes
123
what are 4 differentials for hypokalaemia?
vomiting and diarrhoea diabetic ketoacidosis drug/alcohol induced primary aldosteronism
124
what is the management of hypokalaemia?
oral/IV potassium replacement (KCl)
125
what are 2 complications of hypokalaemia?
severe muscle weakness | paralysis
126
what can cause hypoparathyroidism?
post-surgery genetic and autoimmune conditions iron and copper overload (Wilson's disease) idiopathic
127
what are 3 risk factors for hypoparathyroidism?
thyroid/parathyroid surgery, hypomagnesianism, transfusional iron overload (in thalassaemia)
128
what does parathyroid hormone do?
increase renal calcium absorption and phosphate excretion increased production of 1,25-dihydroxyvitamin D in kidney increase bone calcium resorption increase gut absorption of calcium
129
What are 3 GI presentations of hypoparathyroidism?
malnutrition malabsorption diarrhoea
130
what are 6 neurological presentations of hypoparathyroidism?
``` muscle twitches/spasms parasthesia, numbness and tingling convulsions irregular heartbeat tachycardia Trousseau's and Chvostek's signs ```
131
what are the two signs for hypocalcaemia?
Trousseau’s sign – involuntary wrist spasm causing adduction of thumb, flexion of MCP joints and extension of interphalangeal joints with wrist flexion (Italian hand) Chvostek’s sign – twitching of facial muscle due to tapping over facial nerve
132
What are 5 investigations that can be done in hyperparathyroidism?
``` serum calcium (low) + albumin ECG - prologue QT, arrythmias plasma intact PTH low/normal serum magnesium (may be low) serum 25-hydroxy vitamin D - may be low serum phosphorus and creatinine - elevated ```
133
What are 3 differentials for hypoparathyroidism?
hypovitaminosis D hypomagnaesaemia renal failure/CKD
134
a deficiency of what mineral exacerbates hypocalcaemia?
magnesium
135
what are 3 complications of hypoparathyroidism?
ectopic calcifications cataracts renal insufficiency
136
what are the two forms of thyroid hormone?
thyroxine - T4 | triiodothyronine - T3
137
What are 5 causes of hypothyroidism?
``` Hashimotos (most common cause in developed world) iodine deficiency thyroidectomy radiation drugs - lithium ```
138
what are 5 risk factors for hypothyroidism?
``` Female Middle age Post-partum radiotherapy DMT1 ```
139
What are 6 signs/symptoms of hypothyroidism?
``` lethargy constipation weight gain dry/coarse skin and hair bradycardia cold sensitivity ```
140
what are the tests for hypothyroidism?
Thyroid function tests - TSH increased and T3/4 low in primary, both low in secondary Antibody tests
141
what are 3 differentials for hypothyroidism?
depression, Alzheimer's, anaemia
142
what is the first line management of hypothyroidism?
levothyroxine
143
what are 5 complications of hypothyroidism?
``` angina atrial fibrillation osteoporosis myxoedema coma increased risk of lymphoma ```
144
What is phaeochromacytoma?
A tumour arising from catecholamine-producing chromaffin cells of the adrenal medulla
145
where can phaeochromacytomas be?
either in chromatin cells of adrenal medulla (90%) or extra-adrenal
146
what are 4 risk factors for phaeochromacytomas?
MEN syndrome 2A/B Von Hippel-Lindau syndrome neurofibromatosis type 1 succinate dehydrogenase subunit B/D gene mutation
147
what enzyme converts adrenaline and noradrenaline to their inactive forms? what are their inactive forms?
catechol-O-methyltransferase (COM) | metanephrine and normetanephrine
148
are extra-adrenal phaeochromacytomas more common in children or adults and are they more likely to be malignant or not?
Children | more likely to be malignant
149
what are 6 key presentations of phaeochromacytomas?
``` headache palpitations diaphoresis (sweating) hypetension impaired glucose tolerance panic attacks and sense of doom ```
150
What are 4 investigations that can be done for phaeochromacytomas?
24 hour urine collection of catecholamines, metanephrines, normeanephrines and creatinine - elevated serum free metanephrines and normetanephrines plasma catecholamines genetic testing
151
what are 4 differentials of phaeochromacytomas?
anxiety and panic attacks essential hypertension hyperthyroidism cardiac arrhythmias
152
what is the management of phaeochromacytomas?
``` control hypertension alpha blockers (phenoxybenzamine) beta blockers calcium channel blockers high salt diet surgical removal of tumour radiation/ablation of tumour ```
153
what are 4 complications of phaeochromacytomas?
hypertensive crisis MI hypotension neurological complications
154
what are 3 risk factors for pituitary adenomas?
MEN-1 familial associated pituitary adenoma Carney complex
155
What are 4 key presentations of pituitary adenomas?
compressive effects - headache, bitemporal hemianopia, cranial nerve palsy, DI Cushing's Acromegaly Prolactinoma - galactorrhea, lack of libido, erectile dysfunction
156
What are 5 investigations that can be done in pituitary adenomas?
``` MRI testosterone/oestrodiol levels (low) Morning cortisol - Low TSH and free thyroxine - low prolactin - may be elevated ```
157
what are 3 differentials for pituitary adenomas?
infection meningioma rathke's cleft cyst
158
what is the management of pituitary adenomas?
``` transsphenoidal surgery observation hormone replacement radiotherapy dopamine agonist ```
159
what are 3 complications of pituitary adenomas?
meningitis Diabetes insipidus hypopituitarism
160
what is primary hyperparathyroidism?
an endocrine disorder in which autonomous overproduction of parathyroid hormone (PTH) results in derangement of calcium metabolism. inappropriate secretion of parathyroid hormone
161
what cases primary hyperparathyroidism?
``` 80% due to benign parathyroid adenoma MEN1/2A/4 - autosomal dominant <1% due to parathyroid malignancy external neck irradiation lithium therapy ```
162
what are 4 risk factors for primary hyperparathyroidism?
female >50-60 FHx MEN 1/2A/4
163
what is the pathophysiology of primary hyperparathyroidism?
PTH is inappropriately not suppressed in high calcium levels leading to over stimulation of bone resorption, kidney absorption and vitamin D conversion causing high levels of calcium
164
What are the 4 clinical presentations of primary hyperparathyroidism?
stones - renal stones and colic bones - pain, fractures and osteoporosis moans - abdo pain, malaise, nausea, constipation psychic groans - depression and anxiety
165
what are 3 investigations of primary hyperparathyroidism?
serum calcium - high normal/raised serum intact PTH with immunoradiometric or immunochemical assay - raised parathyroid immune assay - elevated serum calcium and inappropriate raised PTH
166
what are 4 differentials for primary hyperparathyroidism?
secondary hyperparathyroidism familial hypocalciuric hypercalcaemia multiple myeloma thiazide use
167
what is the management of primary hyperparathyroidism?
1 - parathyroidectomy, monitoring | adjuncts - vitamin D supplementation, bisphosphonates (osteoporosis), cinacalcet
168
what are 3 complications of primary hyperparathyroidism?
recurrent laryngeal nerve injury with surgery hypocalcaemia osteoporosis
169
what is secondary adrenal insufficiency?
decreased cortisol production as a result of negative feedback on the hypothalamic-pituitary-adrenal axis, caused by excess glucocorticoids
170
what kind of patients is secondary adrenal insufficiency common in?
those treated with glucocorticoids - asthma, COPD, arthritis
171
what 3 causes of secondary adrenal insufficiency?
exogenous glucocorticoids glucocorticoid secreting adrenal adenomas hypothalamic pituitary disease
172
what are 2 risk factors for secondary adrenal insufficiency?
glucocorticoids | medroxyprogesterone use
173
what is the pathophysiology of secondary adrenal insufficiency?
Exposure to excess glucocorticoids => negative feedback to hypothalamus-pituitary-adrenal axis => patients may have Cushing’s symptoms due to excess glucocorticoids
174
What are 5 clinical presentations of secondary adrenal insufficiency?
tachycardia hypotension Cushingoid examination features shock - fatigue, abdo pain, weakness, vomiting, hypotension
175
What are 5 investigations for secondary adrenal insufficiency?
serum chemistry panel - electrolyte abnormalities serum a.m cortisol - low salivary am cortisol - low FBC - WBCs may be elevated thyroid function test - possible elevated free thyroxine
176
what is the gold standard test for secondary adrenal insufficiency?
ACTH stimulation test - cortisol levels won't rise enough in secondary adrenal insufficiency
177
what are 4 differentials for secondary adrenal insufficiency?
primary adrenal insufficiency pituitary compression tumour head trauma
178
what is the treatment for primary adrenal insufficiency ?
hydrocortisone - in crisis double dose corticosteroid in minor crisis corticosteroid taper in stable patients supportive measures
179
what are 2 complications of primary adrenal insufficiency?
corticosteroid dependence | permanent recurrence of adrenal crisis
180
What is syndrome of inappropriate ADH?
Continues secretion of ADH despite plasma being very dilute leading to retention of water, excess blood volume and hyponatraemia
181
what is the most common electrolyte disorder?
hyponatraemia
182
What can cause SIADH?
``` neuro - meningitis, stroke, trauma Malignancy - small cell most commonly infections - TB, HIV, pneumonia endocrine Drugs - chemo, antidepressants, recreational, diuretics, ACEI, SSRIs ```
183
what are 6 risk factors for SIADH?
50+ pulmonary conditions malignancy Drugs
184
what are 6 clinical manifestations of SIADH?
``` altered mental status seizures coma nausea, vomiting, headache absence of hypovolaemia ```
185
what are 5 investigations for SIADH?
``` Serum sodium - low Serum osmolality - low serum urea - usually low urine osmolality - high urine sodium - high ```
186
what are 4 differentials for SIADH?
psudohyponatraemia due to hyperglycaemia hyperlipidaemia renal failure Addison's disease
187
what is the plasma osmolality equation?
plasma osmolality = 2 (Na+) + 2(K+) + glucose + urea (all in mol/L)
188
what is the management for SIADH?
1st - IV hypertonic saline, vasopressin receptor antagonist (vaptans) adjuncts - frusomide, treat underlying
189
what is a complication of SIADH?
central pontine myelinolysis
190
what can cause central pontine myelonolysis?
rapid sodium serum correction >12mEq/L/Day
191
what is the most common endocrine malignancy?
thyroid cancer
192
when is thyroid cancer most common?
early adulthood - 30s-40s
193
what are the 4 most common thyroid cancers?
papillary follicular anapaestic medullary
194
what are 3 risk factors for thyroid cancer?
head and neck irradiation female FHx
195
What are 6 presentations of thyroid cancer?
``` palpable thyroid nodule hoarse voice dyspnoea (SOB) dysphagia rapid neck enlargement tracheal deviation ```
196
what are 4 investigations for thyroid cancer?
Thyroid function test Neck ultrasound - nodules fine needle biopsy larangoscopy
197
what are 2 differentials for thyroid cancer?
benign thyroid nodule | goitre
198
what is the management of thyroid cancer?
surgery - lobectomy radioactive iodine ablation TSH suppression chemo thyroid replacement after
199
what are 4 complications of thyroid cancer?
hypocalcaemia (parathyroid injury) airway obstruction recurrent laryngeal nerve injury secondary tumours
200
where is erythropoietin produced and what does it do?
kidneys (peritubular cells) | stimulated maturation of erythrocytes
201
What is the blood supply to the adrenal glands?
superior adrenal artery - from inferior phrenic middle adrenal artery - from abdominal aorta inferior adrenal artery - from renal artery
202
what does the zone glomerulosa produce?
Mineralocorticoids | ALDOSTERONE
203
what does the zone fasiculata produce?
Glucocorticoids | CORTISOL
204
what does the zone reticularis produce?
ANDROGENS
205
what are corticosteroids?
mineralocorticoids + glucocorticoids (aldosterone + cortisol)
206
what do mineralocorticoids do?
regulate body electrolytes | aldosterone - maintain salt balance, BP, RAAS
207
what triggers the secretion of aldosterone?
release of renin by juxtaglomerular cells in afferent arterioles of kidneys
208
what is the function of cortisol?
suppresses immune system inhibits bone formation increases metabolism - protein catabolism & lipolysis, gluconeogenesis, increases alertness.
209
what triggers secretion of cortisol?
stress => hypothalamus => corticotrophin releasing hormone (CRH) => anterior pituitary => adrenocorticotropic releasing hormone (ACTH) => cortisol release from adrenal cortex
210
what does adrenaline release stimulate?
``` gluconeogenesis lipolysis tachycardia redistribution of circulating volume vasoconstriction vasodilation (due to less noradrenaline) ```
211
what vertebral level is the thyroid located at?
C5-T1
212
what is the connection called in the thyroid?
isthmus
213
what arteries supply the thyroid?
superior and inferior thyroid arteries
214
what week in utero does thyroxine begin to be releases?
18-20 weeks
215
what is produced in the parafolicular cells/ C cells?
calcitonin
216
what is produced in the follicular cells of the thyroid?
T3 and T4
217
what does the follicle of the thyroid contain?
thyroglobulin - iodine store
218
what embryological tissue is the anterior pituitary formed from?
Ectoderm - Rathke's pouch
219
what embryological tissue if the posterior pituitary formed from?
floor of the 3rd ventricle
220
what 6 hormones are released by the hypothalamus?
``` corticotropin releasing hormone - CRH GHRH thyrotropin releasing hormone - TRH Gonadatrophin releasing hormone - GnRH Dopamine ```
221
what 6 hormones are released by the anterior pituitary?
``` FSH LH Adrenocorticotrophic hormone - ACTH TSH Prolactin GH ``` FLAT PG
222
What 2 hormones are released from the posterior pituitary?
Anti-diuretic hormone | Oxytocin
223
Where in the brain is the ADH release stimulated from in the brain?
supraoptic nucleus
224
Where in the brain is the oxytocin release stimulated from in the brain?
paraventricular nucleus
225
what do delta cells in the pancreas release?
somatostatin
226
What is thyroid storm?
A rare but life threatening condition of untreated thyrotoxicosis (hyperthyroidism) causing irritability, high systolic and low diastolic BP, tachycardia, nausea, vomiting and diarrhoea
227
What is Conn's syndrome?
Primary hyperaldosteronism causing excessive sodium reabsorption leading to hypertension and suppression of angiotensin II.
228
what are 2 causes of Conn's syndrome?
genetics | adrenal adenoma
229
what are 2 risk factors for Conn's syndrome?
FHx | FHx of early onset hypertension/stroke
230
What is the pathophysiology of Conn's syndrome?
Aldosterone producing adenoma => Excessive aldosterone production => increased sodium absorption from distal tubule => if severe hypokalaemia and metabolic acidosis
231
what are 6 clinical manifestations of conns syndrome?
``` refractory hypertension hypokalaemia nocturia/polyuria lethargy muscle weakness/cramps difficulty concentrating and mood disturbances ```
232
what are 3 investigations for Conn syndrome?
aldosterone:renin ratio - low adrenal CT U+E - hypokalaemia
233
what are 3 differentials for conn syndrome?
essential hypertension Liddle syndrome renal artery stenosis
234
what is the treatment of Conn syndrome?
aldosterone antagonist - spironolactone | Adrenalectomy
235
what are 2 complications of conn syndrome?
hyperkalaemia and metabolic alkalosis | perioperative complications - stroke, MI, heart failure, AF
236
what are the normal levels of blood glucose?
3.5-8 mmol/L
237
how much glucose is prodded every day?
200g
238
what organ is the major consumer of glucose in the body?
the brain
239
what are 3 hormones that increase glucose production in live and reduce utilisation in fat and muscle?
cortisol adrenaline GH
240
what chromosome codes for insulin?
11
241
what peptide isn't present in synthetic insulin?
C peptide
242
what transported proteins allow beta cells to sense glucose levels in the blood?
GLUT 2
243
what is a diagnostic random blood glucose value for diabetes?
>11 mmol/L
244
what is a diagnostic fasting blood glucose level for diabetes?
>7 mmol/L
245
what is a diagnostic oral glucose tolerance test level for diabetes?
>11 mmol/L
246
what is the name of a basal insulin?
Levemir
247
what is the name of a bolus insulin?
Humalog
248
what is the leading cause of death in diabetic patients?
CVD
249
what is the 1st line treatment for DMT2 with HbA1c >48 mmol/mol?
Metformin
250
above what HbA1c level is metformin 1st line in DMT2?
48
251
what are 4 side effects of metformin?
anorexia diarrhoea nausea abdominal pain
252
what is the 1st line management of diabetic ketoacidosis? (4)
ABCs IV fluids - slow infusion insulin infusion potassium replacement
253
what are 3 complications of diabetic ketoacidosis?
hypokalaemia hypoglycaemia venous thromboembolism
254
what vertebral levels are the thyroid glands located between?
C5-T1
255
what is the connection between the 2 lobes of the thyroid gland called?
isthmus
256
what 3 disease have diffuse goitres?
Grave's Hashimotos De Quervain's
257
What 3 conditions have nodular goitres?
Multi-nodular Adenomas/cysts Carcinomas
258
what is the most common type of thyroid carcinoma?
papillary
259
what is thyrotoxicosis?
excess thyroid hormones in the blood
260
what is the antibody is grave's disease?
Anti TSH antibody
261
what is De Quervain's thyroididtis?
hyperthyroidism usually preceding viral illness, pain in neck and malaise treat with aspirin
262
what is the treatment of a thyroid storm?
IV fluids antithyroid drugs - Propylthiouracil/carbimazole IV hydrocortisone B Blockers
263
what are 3 eye signs of Graves?
exophthalmos - protruding eyes ophthlmoplegia - paralysis/weakening of eye muscle lid lag stare
264
what thyroid disorder has raised inflammatory markers?
De Quervain's
265
what 3 things does ACTH stimulate the release of from the adrenals?
mineralocorticoids glucocorticoids gonadocorticoids
266
what does the zone glomerulosa respond to?
RAAS system
267
what is the action of aldosterone?
works on kidney to increase blood volume, increase BP. May also cause hypernatraemia.
268
what is the action of cortisol?
suppresses immune system, inhibits bone formation, increases metabolism - protein catabolism & lipolysis, gluconeogenesis, increases alertness.
269
what is the action of gonadocorticoids?
production of oestrogen and testosterone. Main role is controlling libido.
270
when are cortisol levels at their highest?
7-9 am
271
what hormone inhibits GH secretion?
somatostatin
272
what hormone stimulates the release of GH?
Ghrelin
273
what is an adrenal crisis?
acute insufficiency of adrenocortical hormones usually caused by infection or MI causing hypotension, shock and coma
274
what is the management for an adrenal crisis?
IV fluids Corticosteroids - hydrocortisone IV treat underlying cause
275
what is diabetes insipidus?
a metabolic disorder characterised by an absolute or relative inability to concentrate urine, resulting in the production of large quantities of dilute urine.
276
what are 3 nephrogenic causes of DI?
drugs genetics intrinsic kidney disease
277
what are 3 cranial causes of DI?
brain tumours infections TRAUMA
278
what are 3 risk factors for DI?
pituitary surgery brain injury autoimmune disease
279
what are 5 manifestations of DI?
``` postural hypotension hypernatraemia polyuria polydipsia dehydration ```
280
what is the gold standard investigation for DI?
water deprivation desmopressin suppression test
281
what are 3 first line investigations for DI?
U+E - hypernatraemia Serum glucose urine osmolality - low
282
what are 3 differentials for DI?
DM hypercalcaemia primary polydipsia
283
what are 2 management options for DI?
``` desmopressin (if cranial) thiazide diuretics (bendroflumethiazide) - encourages kidneys to take up more Na+ and thus water ```
284
what are 4 causes of hypercalcaemia?
acidosis osteoclastic bone resorption sarcoidosis excess vitamin D
285
what are 5 manifestations of hypercalcaemia?
``` abdo pain vomiting constipation dehydration absent reflexes muscle weakness ```
286
what is a differential for hypercalcaemia?
hyperalbuminaemia
287
what is the management for hypercalcaemia?
``` rehydration loop diuretics (furosemide) glucocorticoids bisphosphonates calcitonin ```
288
what are 4 complications of hypercalcaemia?
kidney stones renal failure ectopic calcification cardiac arrest
289
how do you remember the manifestations of hypercalcaema?
bones moans stones psychic groans
290
what are 4 causes of hypocalcaemia with hyperphosphataemia?
CKD hypoparathyroididsm pseudohypoparathyroidism acute rhabdomyolysis
291
what are 4 causes of hypocalcaemia with normal phosphate?
vitamin D deficiency osteomalacia acute pancreatitis over hydration
292
what are 8 manifestations of hypocalcaemia?
``` SPASMODIC Spasms - troussau's Paraesthesia anxious seizures Muscle tone increase Orientation impaired Dermatitis Impetigo herpetiformis Chvosteks sign - facial muscle twitches after facial nerve tapped ```
293
what are the ECG signs of hypocalcaemia?
prolonged QT and ST arrhythmia torsade de pointes AF
294
what is the management for hypocalcaemia?
calcium suplements - calcium gluconate | vitamin D supplements - alfacalcidol
295
what are 5 manifestations of neuroendocrine tumours?
``` diarrhoea SOB flushing itching RUQ pain - hepatic metastases ``` Worsened by ALCOHOL
296
how is insulin secreted?
hyperglycaemia leads to increased glucose uptake by cells/. Glucose metabolism leads to increased levels of ATP within the cell which causes K+ channels to close leading to the depolarisation of the cell membrane. Ca2+ channels open and calcium enters the cell. Increased calcium leads to exocytosis of insulin containing vesicles so insulin is released from the pancreatic beta cells into the blood stream.

Phase 2A :!: (14 decks)

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