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Endocrine Flashcards

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1
Q

Describe endocrine effects of hypothalamus

A

ADH and oxytocin to posterior pituitary
Release hormones to anterior pituitary

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2
Q

Describe endocrine effects of posterior pituitary

A

ADH to kidneys
Oxytocin to Breast and uterus

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3
Q

Describe endocrine effects of anterior pituitary

A

ACTH to adrenals
Oxytocin to breast
FH and LSH to ovaries/testes
GH to bones/tissues
TSH to thyroid

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4
Q

Describe endocrine axis of adrenals

A

Hypothalamus releases CRH to ant. pituitary which release ACTH to adrenals

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5
Q

Describe layers and products of adrenals

A

cortex
- zona glomerular: mineralocorticoids
- zona fasciular: glucocorticoids
- zona reticular: androgens
medulla
- adrenaline/noradrenaline

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6
Q

What is acromegaly and what are the causes

A

increase in GH
pituitary adenoma
cancer releasing GH or GHRH

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7
Q

Visible symptoms of acromegaly

A

Frontal bossing, protruding jaw
large nose, large tongue
galactorrhoea

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8
Q

Organ dysfunction with acromegaly

A

HTN
cardiomegaly
diabetes
colorectal cancer

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9
Q

Symptoms of acromegaly caused by pituitary tumour

A

headaches
bitemporal hemianopia (pressing on optic chiasm)

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10
Q

Diagnosis of aromegaly

A

Raised IGF-1
OGTT
If GH >1 following glucose +ve

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11
Q

Management of acromegaly

A

1) transphenoidal surgery to remove
2) Medical management
- somatostatin analogue to inhibit GH release (octreotide)
- GH receptor antagonist (pegvisomant)
- dopamine agonist (bromocriptine)

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12
Q

What is Addisons

A

primary hypoaldosteronism due to autoimmune dysfunction of adrenals
other causes inc TB, metastatic carcinoma

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13
Q

Describe the RAA pathway

A

dehydration/low Na causes low blood volume and BP
Reduced renal perfusion causes release of renin by juxtaglomerular cells
Combined with angiotensinogen (liver) produces angiotensin I, combined with ACE (lungs) produces angiotensin II
Causes adrenals to produce aldosterone which increased Na and H20 reabsorption and increases blood volume/BP

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14
Q

Physiological cortisol response to stress

A

stress causes increased cortisol which causes increased gluconeogenesis in liver
- breakdown of muscle to produce amino acids
- breakdown of adipose tissue to produce free fatty acids

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15
Q

Describe presentation of Addisons where zona glomerular is affected

A

less aldosterone
- increased K+ and decreased Na
- salt cravings
- N&V
- dizziness
- fatigue

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16
Q

How do you manage an Addisonian crisis

A

IV hydrocortisone
IV NaCl ± dex

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16
Q

Describe presentation of Addisons where zona fascicular is affected

A

less cortisol therefore less glucose
- fatigue
- overactive pituitary releases proopiomelanocortin -> melanocyte stimulating hormone->hyperpigmentation

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16
Q

Describe presentation of Addisons where zona reticular is affected

A

less androgens
- mainly affects females because males also get testosterone from testes
- loss of pubic hair
- decreased sex drive

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16
Q

How do you interpret a 9am cortisol

A

> 500 addisons unlikely
100-500 do SST
<100 abnormal

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16
Q

How/why does Addisonian crises occur

A

Major stress creates sudden need for cortisol/aldosterone that cannot be met
- D&V
- pain in back/legs/abdomen
- hypotension
-LOC

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17
Q

How do you diagnose Addisons?

A

short synacthen test
Given synthetic ACTH, measure cortisol and aldosterone produced, if doesn’t rise then +Ve for adrenal insufficiency

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18
Q

What is Cushings syndrome?

A

Increased cortisol

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19
Q

Physiological effects of cortisol

A

1) gluconeogenesis
2) increased sensitivity of peripheral blood vessels to adrenaline
3) decreased immune response

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20
Q

Causes of Cushing Syndrome

A

Exogenous: steroids
Endogenous: pituitary adendoma (Cushings disease), SCLC, adrenal adenoma/carinoma

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21
Symptoms of Cushings syndrome
excess muscle/bone breakdown -muscle wasting, thin skin, bruising, fractures Increased glucose, increased insulin, increased adipose tissues - buffalo hump, moon face, central obesity - Diabetes Increased periperal sensitivity to adrenaline - HTN - infections
22
Imagining in Cushings
MRI pituitary CT adrenal CT TAP (malignancy)
23
Management of Cushings
Exogenous: gradually reduce steroids Pituitary adenoma: surgery Adrenal steroid inhibitors e.g. ketoconazole
24
Risk factors for endometrial cancer
Increased oestrogen - nulliparity - early menache - late menopause - unopposed oestrogen metabolic -obesity - PCOS - Diabetes
25
Protective factors for endometrial cancer
multiparity COCP smoking
26
Presentation of endometrial cancer
PMB
27
Investigation and management of endometrial cancer
TV US Hysteroscopy + biopsy Surgery
28
Symptoms of uterine fibroids
menorrhagia abdo pain, bloating, LUTS subfertility
29
Diagnosis and management of uterine fibroids
TVUS Medical: GnRH antagonists Surgical: myomectomy, endometrial ablation, hysterectomy
30
Types of urinary incontinence
1) urge: detrusor overactivity 2) stess: when laughing/coughing 3) Overflow 4) Functional 5) mixed: urge/stress
31
Management of urge incontinence
bladder retraining 6/52 antimuscarinics (oxybutynin) mirabegron (elderly)
32
Management of stress incontinence
Pelvic floor exercises 3/12 surgery duloxetine
33
Features of PCOS
subfertility, infertility menstrual disturbance hirsutism, acne obesity acanthosis nigricans
34
Diagnosis of PCOS
requires 2 out of the following 3 1) infrequent or no mestration 2) signs of increased androgens e.g hirsutism, acne, increased testosterone 3) polycystic ovaries on USS
35
Causes of hypothyrodism
primary - hashimotos thyroiditis -de Quervains - Riedel - thyroidecomy - lithium, amiodarone Secondary - pituiarty failure
36
Conditions associated with hypothyroidism
Downs Turners Coeliac
37
Symptoms of hypothyroid
Hair loss, dry skin weight gain, fluid gain fatigue constipation cold sensitive
38
Investigations of hypothryoidism
primary: low T3/T4 high TSH Secondary: Low T3/T4 low TSH
39
Management of hypothyroidism
levothyroxine - titrate until normal TSH Increase in pregnancy
40
SE of levothyroxine
AF, worsening angina, reduced bone mineral density
41
What is de Quervains
Sub acute thyroiditis following viral infection
42
How does de Quervains present
Phase 1: 3-6 weeks -hyperthyroid, goitre, raised ESR Phase 2 1-3 weeks: euthyroid Phase 3 weeks/months Hypothyroid Phase 4: normal
43
How do you diagnose de Quervains
thyroid scintigraphy - decreased iodine 131 uptake
44
How do you manage de Quervains
self limiting, steroids if severe
45
What is subclinical hypothyroidism
High TSH, normal T3/T4 with no symptoms
46
How do you manage subclinical hypothyroidism
If TSH >10 on 2 occasions more than 3 months apart - give levo If TSH 5.5-10 on 2 occasions more than 3 months apart and symptomatic - give levo if TSH 5.5-10 and >65 repeat in 6 months
47
What causes thyroid eye disease
Graves inflam of muscles behind eye
48
How do you prevent/manage thyroid eye disease
Prevent: stop smoking Treat: steroids, topical lubricants, radiotherapy, surgery
49
Causes of hyperthyroidism
Graves Toxic multinodular goitre Pituitary/hypothalamic pathology
50
Symptoms of hyperthyroidism
Heat intolerance, sweating weight loss tachycardia loose stools
51
How does Graves present?
hyperthyroid symptoms + diffuse goitre, eye disease, pretibial myxoedema
52
What is a thyroid storm
triggered by trauma. infection, contrast -pyrexia - N&V - tachycardia - Hypertension -Delerium
53
Thyroid storm management
fluids, b blockers, steroids, anti-arrhythmics
53
Management of hyperthyroidism
1) carbimazole 2) propylthiouracil - less used because risk of hepatic injury 3) radioactive iodine, surgery + levo
54
Causes and management of subclinical hyperthyroidism
multinodular goitre excessive thyroxine m:: low dose anti thyroid agent 6 months
54
How do you diagnose and treat toxic multinodular goitre
patchy update on nuclear scintigraphy mx: radioiodine therapy

MRCP (19 decks)

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