Endocrine Flashcards
(141 cards)
1
Q
What investigation results do you need to have to diagnose diabetes?
A
2 of: or 1 + symptoms:
random blood glucose over 11
fasting blood glucose over 7
more than 11 after glucose tolerance test
2
Q
what is C peptide?
A
used to test for diabetes especially if atypical
Produced in the breakdown of insulin
So if T1DM there will be no C peptide
3
Q
when should you take bolus insulin?
A
30 mins before a meal
4
Q
what is the criteria for borderline diabetes?
A
oral glucose tolerance test above 7.8
fasting glucose above 6.1
hba1c above 42
5
Q
what indications are there that metformin is not sufficient?
A
HbA1c is above 58
6
Q
gliclazide is what type of drug, what does this do?
A
gliclazide = sulphonylurea
stimulate insulin release
= hypoglycaemia
7
Q
what kind of drug is dapaglifozin?
A
SGLT2 inhibitor
glucose excretion into urine (fozin like urine)
8
Q
exanatide is what kind of drug?
A
GLP-1 analogue
increase insulin and satiety
9
Q
sitagliptin is what kind of drug?
A
DPP-4 inhibitor (prevents breakdown of GLP-1)
10
Q
pioglitazone is what kind of drug?
A
thiazolidinedione
increased insuline sensitivity and decrease liver gluconeogenesis
CV side effects
11
Q
in type II diabetes what type of insulin do you start with?
A
basal
12
Q
what amount of glucose is level 2 hypoglycaemia?
A
3-3.9
13
Q
diagnostic triad for hypoglycaemia?
A
symptomatic
biochemical
resolves with glucose
14
Q
what is the pathophysiology of diabetic ketoacidosis?
A
lack of insulin = metabolise amino acids and triglycerides for energy
lipolysis = high serum levels of free fatty acids and alanine
glucagon stimulates ketogenesis (fatty acids – ketones)
= metabolic acidosis
15
Q
what 3 things must there be in DKA?
A
hyperglycaemia
urinary ketones
metabolic acidosis
16
Q
treatment of DKA?
A
slow rehydration
insulin
replace electrolytes
treat underlying cause
17
Q
what can hyperosmolar hyperglycaemic state cause?
A
AKI
hypotension
coma
stroke etc (as hyperviscosity of blood because not enough water)
18
Q
management of hyperosmolar hyperglycaemic state?
A
fluid (saline)! To dilute
insulin after that if still needed
19
Q
3 macrovascular complications of diabetes?
A
stroke
IHD
heart failure
peripheral vascular disease
20
Q
3 microvascular complications of diabetes?
A
neuropathy (inc autonomic = GI disturbance)
renal dysfunction
retinopathy
21
Q
two stages of retinopathy and what briefly happens in them?
A
non proliferative: fluid leaks into macula = blurred vision
proliferative: new blood vessels try to grow but are not very strong
22
Q
how does MODY1 present?
A
neonatal macrosomia and hyperglycaemia
23
Q
what is MODY2?
A
GCK glucose sensor mutation
produces a mild diabetes
24
Q
what is MODY-3?
A
most common
responds to sulphonylurea eg gliclazide
25
what is HNF MODY diabetes caused by?
decreased beta cell proliferation
26
how does adrenal disease impact glucose/diabetes?
acromegaly, cushings, increased adrenal activity = decreased insulin sensitivity -- diabetes like picture
27
what is the simple function of thyroid hormone?
increases BMR, increases use of the body's resources
28
what is the basic function of growth hormone?
breakdown of fat and carbs for growth
29
what is the basic function of cortisol?
mobilises glucose for fight or flight
30
what is the basic function of aldosterone?
increase BP, sodium and fluid retention
31
what is the effect of ADH on sodium?
high ADH = low sodium
32
what is Graves?
hyperthryoidism
| because of antibodies to TSH receptors
33
what is toxic multinodular goitre?
high thyroid
| in response to low iodine
34
what is Hashimoto's?
hypothyroid
| because of autoimmune attack of the thyroid gland
35
what is Conn's syndrome?
high aldosterone
36
what is Addisons disease?
low aldosterone, cortisol and androgens
37
what is diabetes insipidus?
low ADH
38
what is the most common type of thyroid cancer?
papillary
39
what class of antibodies (MADGE) are in Graves disease?
IgG
40
are the affects of PTH mediated by osteoclasts or osteoblasts?
osteoblasts
| osteoclasts haven't got a PTH receptor
41
what kind of thyroid disturbance does tyhroiditis cause?
transient hyperthyroidism
42
amiodarone and lithium cause what endocrine disturbance?
hyperthyroidism
| amiodarone can also cause hypothyroidism
43
a choriocarcinoma can cause what endocrine disturbance?
hyperthyroidism
choriocarcinomas secrete hCG
hCG increases thyroid hormone in preparation for pregnancy
44
5 symptoms of hyperthyroidism?
```
tremour
increased heart rate
yawning
restlessness
oligomenorrhoea
irritability
diarrhoea
intolerance to heat
sweating
muscle wasting
eyelid lad/stare
```
45
some symptoms of hyperthyroidism that indicate Grave's is the cause?
```
other autoimmune eg diabetes etc
bulging eyes
acropathy
pretibial myxedema
Goitre
```
46
What do the individual levels of T3/T4 mean?
high T3 and T4 = hyperthyroidism
high T3 = hyperthyroidism
normal T3 high T4 - not significant
47
what antibodies are there in Graves?
anti TSHR IgG
may see:
anti TPO (thyroid peroxidase)
anti thyroglobulin
48
how can you look at the thyroid gland to see the type of goitre?
radioactive iodine uptake scan
49
what drug is used for hyperthyroidism?
carbimazole
50
what is gestational thyrotoxicosis?
nausea and vomitting
wernickes encephalopathy
no goitre or autoimmunity, low TSH high T4
51
what can happen in pregnancy if too much thyroid hormone?
```
poor foetal growth
low birth weight
pre eclampsia
miscarriage
still birth
```
52
what is atropic thyroiditis?
an extreme form of hashimotos, = hypothyroidism
53
symptoms of hypothyroidism?
```
weight gain
cold intolerance
oedema
slow cerebration
delayed reflexes
fatigue
dry cold skin
loss of lateral aspect of eyebrows
goitre
```
54
what antibodies are there in Hashimoto's?
anti-TPO
55
what is subclinical hypothyroidism?
high TSH but (inappropriately) normal T4
56
what is the drug for hypothyroidism?
levothyroxine
57
what can happen if not enough thyroid hormone in pregnancy?
```
hypertension
placental abruption
post partum haemorrhage
low birth weight (this can also happen if hyperthyroid)
preterm
neonatal goitre
neonatal resp distress
If you take levothyroxine you need to increase the dose in pregnancy
```
58
3 signs/symptoms of thyroid cancer?
```
trachial deviation
dysphagia
hoarse voice
palpable nodule in thyroid
raised or decreased thyroid hormone or symptoms of that
```
59
what 2 types of thyroid cancer secrete thyroglobulin?
papillary and follicular
| thyroglobulin is used to make T3 and T4
60
what cells is medullary thyroid cancer from?
the C cells that make calcitonin
61
what are the 3 effects of grehlin?
increases hunger
increases fat deposition
stimulates growth hormone
62
What inhibits growth hormone release? - 3
somatostatin (from hypothalamus)
glucose
dopamine
high IGF-1 or GH, by negative feedback
63
what organ produces IGF-1?
liver
64
3 effects of IGF-1?
Cartilege formation
bone growth
protein synthesis
cell proliferation
65
apart from acral enlargement, give 5 other features of acromegaly?
```
sweating
large hands/feet
carpal tunnel
arthralgia
headache
bitemporal hemianopia
hypogonadal dysfunction
diabetes like - polyuria polydipsia
hyperprolactinaemia
```
66
3 tests for acromegaly?
GH - pulsatile so high GH means little but very low GH suggests is not a tumour
GnRH - if high suggests a problem in hypothalamus
glucose tolerance test.
- - glucose inhibits GH release
- - glucose = fall in IGF-1 normally, if not could be acromegaly
pituitary MRI after you have pos results, to find the tumour
67
what treatment is first line for acromegaly caused by pituitary tumour?
transsphenoidal pituitary surgery
68
give 3 drugs you could give for acromegaly?
somatostatin analogue eg octroetide
dopamine agonist eg bromocriptine
pegvisomant: GH antagonist
69
Cushings disease vs syndrome?
cushings disease = pituitary tumour
| cushings syndrome = glucocorticoid excess from any other cause
70
two primary causes of cushings?
adrenal adenoma
adrenal hyperplasia
micronodular adrenal dysplasia
carney complex syndrome
71
what is a carney complex syndrome?
multiple benign tumours
myxomas (in conn tissue esp heart)
tumours in endocrine glands (-- Cushings etc)
spotty skin
72
5 signs / symptoms of Cushings disease?
```
moon face
bufallo hump
purple striae
muscle wasting
central obesity
achne
bloating
weiight gain
tiredness
menstrual irregularity
```
73
how does cortisol affect the BMR?
cortisol decreases metabolism, this is why cushings = weight gain
74
what is dexamethasone an analogue of?
cortisol
75
how does the dexamethasone test work, what do you use it for?
use it to investigate high cortisol
dexamethasone = cortisol analogue
so AcTH should decrease in response to it (neg feedback)
if AcTH does not decrease is pathological
Cushings disease -- only responds to high dose dexamethasone
ectopic AcTH secreting tumour (eg small cell lung cancer) -- still no response to v high dexamethasone
76
in Cushings when is the best time to measure cortisol?
Midnight, when it should be lowest
| If cortisol is still high at this time you know there is a problem
77
In Cushings when should you measure AcTH, what will the results tell you?
measure at 9am
as cortisol is highest at 9am, ACTH should be lowest
If it is low the problem could be with the adrenals
If it is high the ACTH is being produced when it shouldnt be so the problem is secondayr
78
3 causes of pseudocushings?
alcohol
depression
obesity
pregnancy
79
what is secondary hyperaldosteronism caused by?
high renin, eg
- - renal artery stenosis
- - heart failure (resulting in poor renal perfusion)
80
how does renin cause aldosterone release?
renin = angiotensinogen -- AT1
| AT 2 = aldosterone release from the adrenals
81
what does aldosterone do in the kidney?
increases Na+K+ channels on the luminal membrane of principle cells in the DCT
increases ENaC on the apical membrane of principle cells in the DCT
= increased sodium reabsorption and increased potassium excretion
Increases H+K+ excretion pump = potassium excretion & alkalosis
82
some symptoms of Conns syndrome?
Conns = too much aldosterone
resistant hypertension
alkalosis
hypokalaemia -- cramps
lethargy
83
how would you find renal artery stenosis?
CT angiography
doppler
magnetic resonance angiography (MRA)
84
first line investigation for hyperaldosteronism?
renin:aldosterone ratio
85
is Conns primary or secondary?
Conns is primary hyperaldosteronism, caused by an adrenal tumour/hyperplasia etc
86
treatment for hyperaldosteronism?
aldosterone antagonist - spironolactone, eplerenone
percutanous renal artery angioplasty/stent - if renal artery stenosis
adrenalectomy - if problem is a unilateral tumour
low dose glucocorticoids for familial hyperaldosteronism
87
in this country what is the most common cause of adrenal insufficiency?
Autoimmune adrenalitis
| antibodies against glands or enzymes especially 21 a hydroxylase
88
3 causes of Addisons disease?
```
autoimmune adrenalitis
TB
congenital
metastatic tumour
haemorrhage
amyloidosis
```
89
what is the most common cause of tertiary adrenal insufficiency?
steroids
90
what stimulates AcTH release from the anterior pituitary?
CRH release from the hypothalamus
91
give 4 physiological functions of cortisol?
```
increases HR
increases BP
bronchodilation
glycogenolysis
decreases digestion
decreases urine output
decreases BMR
```
92
symptoms of Addisons disease?
```
hyperpigmented patches of skin
weight loss
muscle wasting
fatigue
poor recovery from inf
hypotension
hyponatraemia
hyperkalaemia
vitiligo
hair loss
dehydration
```
93
symptoms of addisonian crisis?
```
metabolic acidosis
hyperkalaemia
hyponatraemia
hypovolaemic shock
confusion
```
94
when do you measure cortisol if you suspect adrenal insufficiency and what result indicates adrenal insufficiency?
measure at 9am when it should be highest, if low is bad!
100 = hospitalise
more than 500 = fine
95
what is synacthen and how can you use it as a test?
AcTH analogue
should stimulate AcTH receptors = cortisol release
if cortisol is not released in response there is a problem with the adrenals (primary adrenal insufficiency / Addisons disease)
96
why should you measure aldosterone if there is low cortisol?
aldosterone is also released from the adrenals but not under pituitary control
so if aldosterone is normal, problem is with AcTH - pituitary, hypothalamus, steroids
if aldosterone is low the problem is primary, a problem with the adrenals
97
3 causes of hyperkalaemia?
```
adrenal insufficiency
renal dysfunction
tumour lysis syndrome
rhabdomyolysis/ trauma / burns
metabolic acidosis
diabetic ketoacidosis
potassium sparing diuretics eg spironolactone
ACEi because they decrease aldosterone
diet
NSAIDs because they impair renal function
```
98
normally is potassium intracellular or extracellular?
potassium lives in the cell
99
what ECG signs do you see in hyperkalaemia?
tall tented T waves
flat P
wide QRS
100
symptoms of hyperkalaemia?
```
arrythmia
weakness
paresthesia
lightheadedness
tachycardia
diarrhoea
hyper reflexia
```
101
a traumatic blood taking can alter the level of what electrolyte?
potassium
| because it is released from lysed cellls
102
what drug for mild (below 6) hyperkalaemia?
calcium resonium
103
what drugs for bad hyperkalaemia?
insulin/dextrose
calcium gluconate
nebulised salbutamol
IV fluid
sodium bicarb
104
5 causes of hypokalaemia?
conns
cushings
nephrotic syndrome = low kidney BP = RAAS
inadequate diet / malabsorption / laxative
potassium wasting diuretics
renal failure
genetic - barrters / liddles / gietelmans
alkalosis
alcohol
105
5 symptoms of hypokalaemia?
```
arrythmia / palpitations / ectopic beats
muscle weakness / hypotonia
rhabdomyolysis
paralytic ileus
hypotension
respiratory depression
tetany
```
106
ECG changes in hypokalaemia?
flat inverse T wave
U wave
ST depression
prolonged QU
107
what is the oral potassium replacement called?
sandok
108
3 causes of nephrogenic diabetes insipidus?
```
lithium
CKD
post obstructive uropathy
hypokalaemia
hypercalcaemia
inherited V2 receptor defect
diabetes mellitus
```
109
3 causes of cranial diabetes insipidus?
```
brain tumour
head injury
hypophysitis
meningitis
sarcoidosis
pregnancy
```
110
is ADH released when serum osmolarity is high or low?
released when it is high
this means the blood is concentrated and we dont want to be losing anymore water so we will secrete ADH to keep the water
111
presentation of diabetes insipidus?
```
polyuria
polydipsia
dehydration
postural hypotension
hypernatraemia
concentrated blood, diluted urine
```
112
what is desmopressin an agonist of and how is desmopressin used as a test?
desmopressin = V2 agonist
| test for diabetes insipidus
113
what can you use as a marker of DI instead of desmopressin?
copeptin
released in the production of ADH
water deprivation should induce copeptin release
114
treatment for DI? Is this for cranial or nephrogenic?
desmopressin
works well in cranial
no good treatment for nephrogenic but can try desmopressin
115
symptoms of hyponatraemia?
```
nausea
anorexia
lethargy
headache
weakness
myalgia
ataxia
confusion
seizures
LOC
myoclonus
respiratory arrest
```
116
3 causes of SIADH?
```
head injury
brain abscess
guillian barre
pneumonia
asthma
drugs eg carbamazepine
small cell lug cancer
```
117
what is the difference in presentation of Addisons and SIADH?
both have low serum sodium and high urine sodium
in addisons there is usually hypovolaemia but in SIADH the body compensates for this
In addisons there are dark patches on the skin
in addisons ACTH is high
in addisons you also lack cortisol
118
what happens if the person is hyponatraemic and you give them sodium too quickly?
osmotic demyelination
119
treatment for SIADH?
replace sodium with hypertonic saline
tolvaptan
fluid restrict
furosemide
120
If you suspect acromegaly, what are the 1st, 2nd and 3rd line tests?
1st line: IGF-1
2nd : oral glucose tolerance test
3rd: pituitary function tests inc prolactin
4th: MRI pituitary
121
what is the gold standard test for phaeochromocytoma?
elevated free plasma metanephrine
122
3 cancers that cause SIADH?
small cell lung
prostate
pancreatic
thymus
lymphoma
123
complications of acromegaly?
```
obstructive sleep apnoea
carpal tunnel
diabetes
cardiomyopathy
HTN
stroke
```
124
what is the most common cause of primary hyperparathyroidism?
solitary adenoma
125
in hyperaldosteronism what is the most obvious electrolyte distubance?
hyperkalaemia
126
how does carbimazole work?
prevents thyroid peroxidase from coupling and iodinating the tyrosine residues on thyroglobulin
127
what cells is a phaeochromocytoma made of?
chromaffin cells
128
4 causes of hypocalcaemia?
- low vit D
- low PTH (surgery/ digeorge / magnesium deficiency)
- pseudohypoparathyroidism (mutation in PTH receptor)
- kidney disease (so cant reabsorb it)
- osteomalacia
pancreatitis
resp alkalosis
rhabdomyolysis
129
how does calcium affect QT?
```
lOng = hypOcalcaemia
short = hypercalcemia
```
130
two signs of hypocalcaemia?
Trousseau: hand spasm with BP cuff
Chovstek: face twitch
131
parasthesia, spasm, long QT, seizures and basal ganglia calcification suggest high or low calcium?
low
| low calcium = everything more excitable, the QT interval is opposite to what you'd think
132
thirst, hyporeflexia, short QT, pyrexia, hypertension suggest high or low calcium?
high
133
primary vs secondary hyperparathyroidism?
primary: high PTH = high Ca
secondary = low Ca = high PTH
134
how does high calcium affect the neurones?
high calcium = hyperpolarisation = slow and sluggish neurones
135
symptoms of high calcium?
bones (pain)
stones (kidney)
moans (depression)
thrones (constipation)
```
hyporeflexia
hypertension
vomitting
confusion - coma
pyrexia
```
136
what happens in hypercalcaemia of malignancy?
tumour produces ectopic PTHrP
137
what happens in carcinoid syndrome?
```
tumour produces serotonin, bradykinin and histamine
= vasodilation
itching
SOB
diarrhoea
```
138
plasma chromogranin A and urinary 5-HIAA are tests for what?
carcinoid syndrome
139
a drug for carcinoid syndrome?
octreotide
140
3 causes of decreased pituitary function?
```
adenoma
metastates
developmental cyst - rathkes or mucocoele
syphilis
sarcoidosis
granulomatosis with polyangiitis
anneurysm
autoimmune
perisellar meningeoma
```
141
what cells is prolactinoma a tumour of?
| what are some symptoms of prolactinoma?
lactotroph
inhibits FSH and LH = infertility, amenorrhoea
galactorrhoea
low libido
