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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
ss for hyponatraemia
confusion headache balance difficulties low urine output N/V Seizures Coma
26
Management for hyponatraemia
treat underlying problem if present stop any contributing medicines
27
which thyroid hormone is more abundant in blood
T4
28
Which thyroid hormone is more potent
T3
29
What is the levels in primary hypothyroidism
High TSH and low T4
30
what is the levels in secondary hypothyroidism
TSH levels may be low or normal but T4 is below range
31
SS of hypothyroidism
Fatigue cold intolerance Weight gain constipation non specific weakness menstrual irregularities depression dry skin and hair loss
32
Management for hypothyroidism
levothyroxine
33
RF for diabetes types 2
- FHx - Poor diet - Lack of exercise - Obesity - Ethnicity - Hx of gestational diabtes - pcos
34
SS for type 2 diabetes
- Polydipsia - Polyuria - Blurred vision - Unexplained weight loss - tiredness - acanthosis nigricans
35
Ix and diagnostic result for type 1 diabtes
random blood glucose = 11.1 fasting = 7 HbA1C= 48
36
Management for type 2 diabetes
Lifestyle advice DESMOND Screen for complication 1)Metformin - first line 2)dual therapy - metformin +gliptin/pioglitazone/ sulfonylurea/SGLT2-inhibitor 3) Triple therapy
37
what is Addison's disease
occurs when there is a destruction of adrenal cortex leading to reduction of glucocorticoid production
38
primary causes of Addison disease
autoimmune trauma infection like TB
39
Secondary causes of Addison's disease
Congenital base of skull fracture neoplasm CRH deficiency
40
SS of Addison's disease
Hypotension Fatigue and weakness Gi symptoms Syncope Pigmentation
41
diagnostic test for Addison's disease
short synacthen test
42
FBC results in addisons
- 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
Management for addisons
Hydrocortisone
44
if pt has postural hypotension's what med do u give to manage addisons
Fludrocortisone
45
3 main actions of PTH
- 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
layers of the adrenal gland (outer to inner)
-adrenal cotrex comprised off: zonal glomerulosa Zona fasciculata Zona reticularis -Adrenal medulla
47
Function of adrenal medulla
Mainly responsible for synthesis of adrenaline and NA also involved in dopamine production
48
Function of zona reticularis
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
Zona fasciculata function
Thickest part Secrete cortisol and corticosterone→ these hormone regulate carbohydrate metabolism when an individual is in a time of stress
50
Zona glomerulosa function
synthesise mineralocorticoid hormones→ plays an important role in the maintenance of electrolyte and water balance in the body. E.g. Aldosterone
51
what is acromegaly
Acromegaly is a condition resulting from excessive growth hormone secretion, usually due to a secreting pituitary adenoma
52
Diff between acromegaly and gigantism
Acromegaly: after closure of the epiphyses Gigantism: occurs before closure of the epiphyses
53
SS of acromegaly
-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
Ix for acromegaly
OGTT and growth hormone measurement MRI/CT pituatry
55
Management for acromegaly
Surgery Radiation Somatostatin analogues
56
What is cushing's syndrome
excess glucocorticoid and loss of normal aafeedback loop
57
ss of cushings syndrome
striae bruising moon face obesity hypertension thin skin
58
management for cushings disease
- 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
what is conns syndrome
hyper aldosteronism usually caused by an adrenal adenoma
60
SS of conns syndrome
- 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
Management for conns
Surgery Spironolactone
62
what is diabetes insipidus
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
SS of diabetes insipidus
- Polyuria (dilute urine) - Polydipsia - Dehydration
64
what is galactorrhoea
Production of breast milk when not pregnant
65
RF for galactorrhoea
Prolactinoma, hypothyroidism, Cushing’s, acromegaly, medication that ↑ prolactin
66
what is gynaecomastia
abnormal breast tissue in men
67
what is graves disease
hyperthyroidism
68
primary hyperthyroidism levels
Primary- low TSH and high Thyroxine
69
hyperthyroidism ss
Rapid onset malaise fever Breathlessness, hoarse voice, dysphagia palpitation diarrhoea Fatigue exercise intolerance Heat intolerance
70
Management for hyperthyroidism
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
Pathophy of hyperparathyroidism
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
features of hypercalcemia
Painful bones Renal stones Abdominal groans (pain) Psychiatric moans (depression, confusion, lethargy)
73
what is phaeochromocytoma
catecholamine secreting tumour
74
SS of phaeochromocytoma
Episodic HTN, anxiety, tachycardia, headache, sweating, tremor
75
who is thyroid storm most likely to occur inn
it may occur in people with undiagnosed hyperthyroidism or in people who abruptly stopped the medication
76
SS of thyroid storm
fever, tachycardia, agitation, hyperthermia, hypertension, atrial fibrillation, heart failure, jaundice, delirium, and coma
77
Management for thyroid storm
- Symptom control: - IV propranolol - Reduce thyroid activity - Propylthiouracil - Lugol's iodine 4 hours later - carbimazole is second line - IV hydrocortisone to reduce thyroid inflammation
78
what is thyroiditis
inflammation not an infection
79
types of thyroiditis
Hashimoto's de qurevians post partum graves disease toxic multinodular
80
Management for thyroiditis
Aspirin, bedrest, +/- steroids
81
Thyroid neoplastic disease SS
- Enlarging thyroid nodule (painless), hoarseness, difficulty swallowing - “Cold Nodule” on scan
82
What is type 1 diabetes
autoimmune condition in which the immune system targets and destroys the insulin-producing cells of the pancreas
83
SS of type 1 diabetes
Polyuria Polydipsia Weight loss DKA

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