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PA- FCM > Endocrine > Flashcards

Endocrine Flashcards

1
Q

2 common causes of hypercalcemia

A

primary hyperparathyroidism or cancer

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2
Q

Signs and symptoms of hypercalcemia

A

polyuria and polydipsia
dyspepsia
depression
Muscle weakness
constipation
vomiting
abdo pain
cardiac arrhythmias

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3
Q

Ix for hypercalcemia and why

A
  • corrected calcium - raised
  • PTH
  • serum albumin
  • U+ E
  • ALP ( raised in primary hyperparathyroidism, myeloma or bone metastases )
  • LFT
  • TFT (thyrotoxicosis)
    serum phosphate levels
  • ECG
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4
Q

Management for non acute hypercalcemia

A

referral to specialist

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5
Q

Management for acute hypercalcemia

A

treat underlying causes
maintain a generous oral salt and water intake
bisphosphonate

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6
Q

RF for hyperkalaemia

A

Male sex
medication (digoxin, potassium sparing diuretics, NSAIDS, ACEi, ARBs, heparin)
CKD
Addison’s disease
Hypertension

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7
Q

SS for severe hyperkalaemia

A

Paraesthesia
Muscle weakness
Fatigue
Chest pain
SOB
Palpitation

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8
Q

Ix for hyperkalaemia

A

FBC
U+E
Creatinine
ECG

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9
Q

1 Main ECG changes in hyperkalaemia

A

Tall tented T waves

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10
Q

Management for hyperkalaemia

A

A-E approach
Stop any contributory drugs
To protect cardiac membrane - give calcium gluconate
To shift potassium into cells - Insulin- glucose IV infusion
to remove potassium from body - calcium resonium with lactulose

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11
Q

causes of Hypernatremia

A

it represents a deficit of water relative to sodium
Causes :
- Fluid loss without water replacement
- Diabetes insipidus
- Osmotic diuresis
- Cushing’s / conns

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12
Q

SS for hypernatremia

A

Confusion
Irritability
Lethargy
Polydipsia/ polyuria
Dry mouth
Poor skin turgor
Decreased JVP

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13
Q

Ix for hypernatremia

A

U+ E
FBC
Urine osmolality
Urine flow rate

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14
Q

Management for hypernatremia

A

should be corrected slowly over a period of 48 hours - IV fluids

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15
Q

what 2 things control calcium levels

A

parathyroid hormone and vitamin D

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16
Q

some acquired causes of hypocalcaemia

A

hepatic diseases
kidney diseases
vit D deficiency
Hypomagnesaemia
diet
medication
surgery

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17
Q

SS for hypocalcaemia (CATS)

A

Convulsion /muscle cramps
Arrhythmias
Tetany or tingling
Stridor or spasms

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18
Q

Examination findings in hypocalcaemia

A

Chvostek’s signs
Trousseau’s signs

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19
Q

Ix for hypocalcaemia

A

FBC, U+E
Vit D
ECG

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20
Q

Management for Hypocalcaemia

A

Treat where symptomatic
calcium gluconate
oral calcium preparation
calcitriol if renal impairment present

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21
Q

what is hypoglycaemia defined as

A

blood sugar less than 3.5 mmol/L

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22
Q

SS for hypoglycaemia

A

headache
coma and seizures (severe case)
aggression and confusion
Palpitation
hunger
sweating
visible tremor
tachycardia

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23
Q

Management for hypoglycaemia

A

if conscious :simple carbohydrate
if unable to take it orally then ; IM glucagon
then give long acting carbohydrate once level above 4 mmol/litre

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24
Q

RF for hyponatraemia

A

older age
hospitalisation
comorbidities
medication

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25
Q

ss for hyponatraemia

A

confusion
headache
balance difficulties
low urine output
N/V
Seizures
Coma

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26
Q

Management for hyponatraemia

A

treat underlying problem if present
stop any contributing medicines

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27
Q

which thyroid hormone is more abundant in blood

A

T4

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28
Q

Which thyroid hormone is more potent

A

T3

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29
Q

What is the levels in primary hypothyroidism

A

High TSH and low T4

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30
Q

what is the levels in secondary hypothyroidism

A

TSH levels may be low or normal but T4 is below range

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31
Q

SS of hypothyroidism

A

Fatigue
cold intolerance
Weight gain
constipation
non specific weakness
menstrual irregularities
depression
dry skin and hair loss

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32
Q

Management for hypothyroidism

A

levothyroxine

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33
Q

RF for diabetes types 2

A
  • FHx
  • Poor diet
  • Lack of exercise
  • Obesity
  • Ethnicity
  • Hx of gestational diabtes
  • pcos
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34
Q

SS for type 2 diabetes

A
  • Polydipsia
  • Polyuria
  • Blurred vision
  • Unexplained weight loss
  • tiredness
  • acanthosis nigricans
35
Q

Ix and diagnostic result for type 1 diabtes

A

random blood glucose = 11.1
fasting = 7
HbA1C= 48

36
Q

Management for type 2 diabetes

A

Lifestyle advice
DESMOND
Screen for complication
1)Metformin - first line
2)dual therapy - metformin +gliptin/pioglitazone/ sulfonylurea/SGLT2-inhibitor
3) Triple therapy

37
Q

what is Addison’s disease

A

occurs when there is a destruction of adrenal cortex leading to reduction of glucocorticoid production

38
Q

primary causes of Addison disease

A

autoimmune
trauma
infection like TB

39
Q

Secondary causes of Addison’s disease

A

Congenital
base of skull fracture
neoplasm
CRH deficiency

40
Q

SS of Addison’s disease

A

Hypotension
Fatigue and weakness
Gi symptoms
Syncope
Pigmentation

41
Q

diagnostic test for Addison’s disease

A

short synacthen test

42
Q

FBC results in addisons

A
  • Low sodium
  • High potassium
  • Low glucose
  • Low cortisol
  • ACTH: High in primary insufficiency, low/low normal in secondary insufficiency
  • Renin (high in Addisons)
  • Aldosterone (low in Addisons)
43
Q

Management for addisons

A

Hydrocortisone

44
Q

if pt has postural hypotension’s what med do u give to manage addisons

A

Fludrocortisone

45
Q

3 main actions of PTH

A
  • Increases bone resorption → can lead to increases calcium levels in the extracellular fluids
  • Increased reabsorption in the kidney → increases amount of calcium absorbed from loop of Henle and distal tubules. Also it increases the rate of phosphate excretion.
  • Vitamin D synthesis → stimulates formation of vit D which increases calcium absorption from the gut.
46
Q

layers of the adrenal gland (outer to inner)

A

-adrenal cotrex comprised off:
zonal glomerulosa
Zona fasciculata
Zona reticularis
-Adrenal medulla

47
Q

Function of adrenal medulla

A

Mainly responsible for synthesis of adrenaline and NA
also involved in dopamine production

48
Q

Function of zona reticularis

A

Site of biosynthesis of androgen precursors such as DHEA and androstenedione

Responsible for sexual characteristics development during puberty.

Hypothalamus secrete CRH which bind to ant. Pituitary gland which secretes ACTH

49
Q

Zona fasciculata function

A

Thickest part

Secrete cortisol and corticosterone→ these hormone regulate carbohydrate metabolism when an individual is in a time of stress

50
Q

Zona glomerulosa function

A

synthesise mineralocorticoid hormones→ plays an important role in the maintenance of electrolyte and water balance in the body.

E.g. Aldosterone

51
Q

what is acromegaly

A

Acromegaly is a condition resulting from excessive growth hormone secretion, usually due to a secreting pituitary adenoma

52
Q

Diff between acromegaly and gigantism

A

Acromegaly: after closure of the epiphyses

Gigantism: occurs before closure of the epiphyses

53
Q

SS of acromegaly

A

-Large hands and feet
- Outward growth of the jaw and head with increased inter dental spacing and macroglossia
- Headaches
- Erectile dysfunction
- Voice change
- Increased sweating
- Mood disturbances
- Fatigue.

54
Q

Ix for acromegaly

A

OGTT and growth hormone measurement
MRI/CT pituatry

55
Q

Management for acromegaly

A

Surgery
Radiation
Somatostatin analogues

56
Q

What is cushing’s syndrome

A

excess glucocorticoid and loss of normal aafeedback loop

57
Q

ss of cushings syndrome

A

striae
bruising
moon face
obesity
hypertension
thin skin

58
Q

management for cushings disease

A
  • Cushing’s Disease
    • surgical removal of pituitary adenoma +/- bilateral adrenalectomy, radiotherapy
  • Adrenal Adenoma
    • unilateral adrenalectomy
  • Adrenal Carcinoma
    • Adrenalectomy, radiotherapy, chemotherapy
  • Ectopic ACTH
    • Surgical removal if tumour located, radiotherapy, chemotherapy
    • Ketoconazole (high doses) blocks steroid synthesis
59
Q

what is conns syndrome

A

hyper aldosteronism
usually caused by an adrenal adenoma

60
Q

SS of conns syndrome

A
  • Often asymptomatic
  • Hypokalemia – Muscular weakness, fatigue, headache
  • Hypernatraemia → volume retention → Hypertension (not always present)
  • Polyuria and polydipsia - reduced ability of the kidneys to concentrate urine
61
Q

Management for conns

A

Surgery
Spironolactone

62
Q

what is diabetes insipidus

A

Diabetes Insipidus (DI) is a disorder caused by hyposecretion or insensitivity to ADH which leads to polydipsia, polyuria and large amounts of dilute urine.

63
Q

SS of diabetes insipidus

A
  • Polyuria (dilute urine)
  • Polydipsia
  • Dehydration
64
Q

what is galactorrhoea

A

Production of breast milk when not pregnant

65
Q

RF for galactorrhoea

A

Prolactinoma, hypothyroidism, Cushing’s, acromegaly, medication that ↑ prolactin

66
Q

what is gynaecomastia

A

abnormal breast tissue in men

67
Q

what is graves disease

A

hyperthyroidism

68
Q

primary hyperthyroidism levels

A

Primary- low TSH and high Thyroxine

69
Q

hyperthyroidism ss

A

Rapid onset malaise

fever

Breathlessness, hoarse voice, dysphagia

palpitation

diarrhoea

Fatigue

exercise intolerance

Heat intolerance

70
Q

Management for hyperthyroidism

A

Refer to an endocrinoligsits

give beta blocker (propanalol)

anti-thyroid drugs: carbimazole and propylthiouracil

Radioactive iodine treatment- first lline for graves disease

Thyroid surgery

71
Q

Pathophy of hyperparathyroidism

A

Primary:
- one or more parathyroid gland produces excess PTH

Secondary:
- increased secretion of PTH in response to low calcium because of kidney, liver, or bowel disease

Tertiary:
- There is a autonomous secretion of PTH, usually because of chronic kidney disease

72
Q

features of hypercalcemia

A

Painful bones
Renal stones
Abdominal groans (pain)
Psychiatric moans (depression, confusion, lethargy)

73
Q

what is phaeochromocytoma

A

catecholamine secreting tumour

74
Q

SS of phaeochromocytoma

A

Episodic HTN, anxiety, tachycardia, headache, sweating, tremor

75
Q

who is thyroid storm most likely to occur inn

A

it may occur in people with undiagnosed hyperthyroidism or in people who abruptly stopped the medication

76
Q

SS of thyroid storm

A

fever, tachycardia, agitation, hyperthermia, hypertension, atrial fibrillation, heart failure, jaundice, delirium, and coma

77
Q

Management for thyroid storm

A
  • Symptom control:
    • IV propranolol
  • Reduce thyroid activity
    • Propylthiouracil
    • Lugol’s iodine 4 hours later
    • carbimazole is second line
    • IV hydrocortisoneto reduce thyroid inflammation
78
Q

what is thyroiditis

A

inflammation not an infection

79
Q

types of thyroiditis

A

Hashimoto’s
de qurevians
post partum
graves disease
toxic multinodular

80
Q

Management for thyroiditis

A

Aspirin, bedrest, +/- steroids

81
Q

Thyroid neoplastic disease SS

A
  • Enlarging thyroid nodule (painless), hoarseness, difficulty swallowing
  • “Cold Nodule” on scan
82
Q

What is type 1 diabetes

A

autoimmune condition in which the immune system targets and destroys the insulin-producing cells of the pancreas

83
Q

SS of type 1 diabetes

A

Polyuria

Polydipsia

Weight loss

DKA

PA- FCM (10 decks)

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