Endocrine Flashcards

Question

what antibodies are associated with Hashimoto's?

Answer 1

- anti-thyroid peroxidase (anti-TPO) antibodies - anti-thyroglobulin (anti-Tg) antibodies

Answer 2

major post-partum haemorrhage causes avascular necrosis of the pituitary gland leading to hypopituitarism

Answer 3

Weight gain Fatigue Dry skin Coarse hair and hair loss Fluid retention (including oedema, pleural effusions and ascites) Heavy or irregular periods Constipation

Answer 4

- TFTs - thyroid ABs - anti-TPO, anti-Tg - FBC - anaemia

Answer 5

- levothyroxine

Answer 6

- severe hypothyroidism Px - confusion, coma, hypothermia, hypoglycaemia, hyponatraemia Mx - T3/4 replacement (T3 causes arrhythmias) - IV glucose - hydrocortisone if needed - fluids / supportive care

Answer 7

1) low bp sensed by juxtaglomerular cells in afferent arterioles of kidneys stimulating renin secretion 2) renin converts angiotensinogen (from liver) to angiotensin 1 3) angiotensin 1 converted to angiotensin 2 by ACE (released by lungs) 4) angiotensin 2 stimlates aldosterone secretion from adrenals

Answer 8

- increase Na reabsorption - increased K secretion from distal tubules

Answer 9

stress and time of day (AM) stimulate hypothalamus to secrete corticotropin-releasing hormone (CRH) CRH stimulates anterior pituitary to secrete adrenocorticotrophic hormone (ACTH) ACTH stimulates adrenals to secrete glucocorticoids (cortisol, cortisone, corticosterone)

Answer 10

1 - stimulates metabolic rate 2 - increases alertness 3- increases sodium and water reabsorption 4 - increases blood sugar levels 5 - inhibits immune system 6 - inhibits protein synthesis / bone formation

Answer 11

refers to signs and symptoms of prolonged high levels of glucocorticoids in the body.

Answer 12

refers to a pituitary adenoma secreting excessive adrenocorticotropic hormone (ACTH), which stimulates excessive cortisol release from the adrenal glands

Answer 13

C – Cushing’s disease (a pituitary adenoma releasing excessive ACTH) A – Adrenal adenoma (an adrenal tumour secreting excess cortisol) P – Paraneoplastic syndrome E – Exogenous steroids (patients taking long-term corticosteroids)

Answer 14

- Round face (known as a “moon face”) - Central obesity - Abdominal striae (stretch marks) - Enlarged fat pad on the upper back (known as a “buffalo hump”) - Proximal limb muscle wasting (with difficulty standing from a sitting position without using their arms) - Male pattern facial hair in women (hirsutism) - Easy bruising and poor skin healing - Hyperpigmentation of the skin in patients with Cushing’s disease (due to high ACTH levels) may also see: HTN, T2DM, osteoporosis, dyslipidaemia, mental health problems

Answer 15

1. low dose dexamethasone suppression test to confirm cushing's 2. high dose dexamethasone suppression test to determine cause of Cushing's 3. FBCs and U&Es 4. MRI/ CT TAP

Answer 16

low dose - give 1mg dex at night and measure ACTH and cortisol in the AM. dex will normally suppress cortisol so failure to suppress suggests Cushing's high dose - give 8mg dex at night and measure ACTH and cortisol in the AM. high dos is enough to suppress cortisol caused by pituitary adenoma (cushing's disease) but not if due to adrenal adenoma / ectopic ACTH

Answer 17

- stop steroids - Cushing's - transsphenoidal resection of adenoma - Adrenal adenoma - adrenalectomy - adrenal carcinoma - surgery / radio / mitotane - ectopic ACTH - surgery / metyrapone / ketoconazole

Answer 18

development of an ACTH-producing pituitary tumour after the surgical removal of both adrenal glands due to a lack of cortisol and negative feedback. It causes skin pigmentation (high ACTH), bitemporal hemianopia and a lack of other pituitary hormones

Answer 19

excess aldosterone Primary - adrenals producing too much aldosterone, renin low due to high BP Secondary - high renin levels leading to high aldosterone

Answer 20

Primary - Adrenal adenoma - Conn's syndrome - bl adrenocortical hyperplasia (more common) Secondary - reduced renal perfusion e:g - renal artery stenosis - HF - liver cirrhosis / ascites

Answer 21

- asym - HTN, headaches, flushing - metabolic alkalosis - H secretion - hypokalaemia - weakness, cramps, paraesthesia, polyuria, polydipsia, constipation, arrhythmias

Answer 22

1) aldosterone-to-renin ratio (ARR) 2) Raised blood pressure (hypertension) 3) Low potassium (hypokalaemia) 4) Blood gas analysis (alkalosis) 5) CT / MRI 6) renal artery imaging - eg doppler, angiography 7) adrenal vein sampling - which adrenal gland is producing more aldosterone

Answer 23

High aldosterone and low renin indicate primary hyperaldosteronism High aldosterone and high renin indicate secondary hyperaldosteronism

Answer 24

- oral spironolactone or eplerenone Surgical removal of the adrenal adenoma Percutaneous renal artery angioplasty via the femoral artery to treat renal artery stenosis

Answer 25

underproduction of adrenal cortex hormones - mineralocorticoids (aldosterone) and glucocorticoids (cortisol)

Answer 26

damage to adrenal glands means not enough hormones are produced causes: Addison's, infection, surgery, malignancy

Answer 27

damage to pituitary (so not enough ACTH) causes: pituitary adenoma, Sheehan's syndrome, pituitary injury (infection/surgery/malignancy)

Answer 28

inadequate CRH release from hypothalamus causes: cessation of long term steroid use (>3m)

Answer 29

major post-partum haemorrhage causes avascular necrosis of the pituitary gland

Answer 30

- tanned, toned, tired, tearful - fatigue, muscle weakness, cramps, dizziness, fainting, thirst, wt loss, abdo pain, N+V, depression, reduced libido, vitiligo, bronze hyperpigmentation, postural hypotension

Answer 31

ACTH stimulates melanocytes to produce melanin

Answer 32

1) bloods 2) short synacthan test 3) ACTH test 4) adrenal autoantibodies 5) CT/MRI of adrenals or MRI pituitary

Answer 33

Adrenal cortex antibodies 21-hydroxylase antibodies

Answer 34

Hyponatraemia (low sodium) Hyperkalaemia (high potassium) Hypoglycaemia (low glucose) Raised creatinine and urea due to dehydration Hypercalcaemia (high calcium)

Answer 35

- give dose of synthetic ACTH - check blood cortisol before and 30 mins after dose - cortisol level should double failure to double suggests Addison's or significant adrenal atrophy due to secondary insufficiency

Answer 36

- hydrocortisone (double when ill) = glucocorticoid replacing cortisol - fludrocortisone = mineralocorticoid replacing aldosterone - steroid card, ID tag, IM hydrocortisone

Answer 37

- acute severe adrenal insufficiency - eg infection, trauma Px - low GCS, hypotension, low BMs, low Na, high K Mx - IM/IV hydrocortisone (100mg stat), IV fluids, IV dextrose

Answer 38

- excess GH in adults due to pituitary adenoma (most common) or ectopic production of hormones involved in growth hormone axis (GH/ GHRH) (usually cancer e.g. lung/pancreas)

Answer 39

bitemporal hemianopia

Answer 40

Excess growth hormone causes tissue growth: - Prominent forehead and brow (frontal bossing) - Coarse, sweaty skin - Large nose - Large tongue (macroglossia) - Large hands and feet - Large protruding jaw (prognathism) Additional features include: - headaches - Hypertrophic heart - Hypertension - Type 2 diabetes - Carpal tunnel syndrome - Arthritis - Colorectal cancer

Answer 41

- IGF-1 = raised - growth hormone suppression test = 75g glucose drink with growth hormone tested at baseline and 2 hours following the drink.Glucose should suppress GH level. Failure to suppress GH suggest acromegaly. - MRI pituitary

Answer 42

1. surgical = transsphenoidal resection of adenoma 2. medical = IM octreotide (somatostatin analogue) - oral cabergoline, bromocriptine (dopamine agonist) - SC pegvisomant (GH receptor antagonist)

Answer 43

Px = small physical features, low energy levels, short stature Ix = low IGF-1 Mx = daily injections of recombinant human growth hormone

Answer 44

Autoimmune destruction of beta cells in pancreas leading to lack of insulin production and a high blood glucose

Answer 45

- DKA - polyuria - polydipsia - wt loss

Answer 46

4.4 – 6.1 mmol/L.

Answer 47

beta cells in the Islets of Langerhans in the pancreas

Answer 48

insulin causes: - cells to take up glucose from blood - prompt muscle/liver cells to absorb glucose and store it a glycogen (glycogenesis)

Answer 49

alpha cells in the Islets of Langerhans in the pancreas

Answer 50

- released in response to low blood glucose / stress - prompts liver to breakdown glycogen to release as glucose = glycogenolysis - prompts liver to convert fat/protein into glucose = gluconeogenesis

Answer 51

- usually clinical - urine dip for glucose and ketones - fasting glucose and random glucose - ? c-peptides - not routine - ? autoantibodies to distinguish T1 and T2

Answer 52

if symptomatic: fasting glucose greater than or equal to 7.0 mmol/l random glucose greater than or equal to 11.1 mmol/l (or after 75g oral glucose tolerance test asymptomatic? as above but on 2 separate occasions

Answer 53

1. Subcutaneous insulin 2. Monitoring dietary carbohydrate intake 3. Monitoring blood sugar levels upon waking, at each meal and before bed 4. Monitoring for and managing complications, both short and long term S/C insulin - ideal is basal-bolus regime

Answer 54

- Background, long-acting insulin injected once a day - Short-acting insulin injected 30 minutes before consuming carbohydrates (e.g., at meals)

Answer 55

pumps that continuously infuse insulin at different rates to control blood sugar levels. They are an alternative to basal-bolus regimes

Answer 56

- Don't stop insulin - Check BMs more frequently - Consider checking ketones - Maintain normal meal pattern if possible - carb drinks if necessary - Drink plenty fluids

Answer 57

- atherosclerosis - stroke - IHD - PVD Acute - DKA, HHS, hypos

Answer 58

- diabetic retinopathy - nephropathy - neuropathy - infections (UTI, pneumonia, skin)

Answer 59

- hypos - lipodystrophy - weight gain

Answer 60

increased insulin resistance and decreased production, leading to persistent hyperglycaemia

Answer 61

- non-modifiable - older age, Black / South Asian, FHx - modifiable - obesity, sedentary lifestyle, high sugar die

Answer 62

- asym - fatigue - polyuria, polydipsia - wt loss - opportunistic infections - eg oral thrush - slow wound healing - acanthosis nigricans

Answer 63

HbA1c of 42 – 47 mmol/mol indicates pre-diabetes

Answer 64

HbA1C >48 mmol (6.5%) [asymptomatic? need two positive tests. symptomatic? 1 positive test]

Answer 65

Serum blood glucose - fasting >7, IGT 6.1-6.9 - random >11.1, IGT 7.8-11 OGTT - >11.1 2hrs after 75g glucose - diagnostic

Answer 66

48 mmol/mol for new type 2 diabetics 53 mmol/mol for patients requiring more than one antidiabetic medication

Answer 67

lifestyle: - Low-glycaemic-index, high-fibre diet - exercise - weight loss - manage complications e.g. HTN

Answer 68

1st line = metformin [ + SGLT-2 if cardiovascular disease or HF ] 2nd line = add sulfonylurea / pioglitazone / DPP4 inhibitor / SGLT-2 inhibitor 3rd line = triple therapy [metformin + 2 of the 2nd line drugs] or insulin therapy 4th line (triple therapy failure and patient BMI >35) = GLP-1

Answer 69

- Some OHAs may be stopped, restart once feeling better - Metformin - stop if risk of dehydration - Sulfonylureas - increase hypo risk - SGLT-2 - check ketones - GLP-1 - stop if dehydrated - Monitor BMs more

Answer 70

Group 1 - insulin - can drive if has hypo awareness, <1 bad hypo in last 12mo, no visual impairment - tablets - no need to notify DVLA - diet controlled - no need to notify Group 2 must meet - no severe hypos <12mo - control of condition, monitoring etc - understand hypo risks - no cx of DM

Answer 71

- Glove + stocking sensory loss - If painful - neuropathic pain meds, pain clinic Also GI autonomic neuropathy - Gastroparesis - erratic blood control, bloating, vomiting, Mx with metoclopramide, domperidone, erythromycin - Chronic diarrhoea - GORD

Answer 72

- from neuropathy / PAD - loss of sensation, absent foot pulses, reduced ABPI - calluses, ulcers, Charcot's arthropathy, cellulitis, osteomyelitis, - screen annually - palpate pulses, 10g monofilament

Answer 73

- increases insulin sensitivity and decreases glucose production by the liver S/Es - GI Sx: including pain, nausea and diarrhoea (depending on the dose) - Lactic acidosis (e.g., secondary to acute kidney injury) NB does not cause weight gain or hypoglycaemia

Answer 74

- block action of sodium-glucose co-transporter 2 protein in kidneys, inhibiting glucose resorption and increasing urinary glucose loss S/Es - increased frequency of UTI and genital thrush - DKA - Fournier's gangrene - inreased urine output

Answer 75

- increase insulin sensitivity, decrease liver glucose production S/Es - Weight gain - Heart failure - Increased risk of bone fractures - small increase in bladder Ca risk

Answer 76

- stimulate insulin secretion from pancreas S/Es - Weight gain - Hypoglycaemia

Answer 77

- enhance incretin effect (increased insulin response to oral glucose) - increase insulin, lower glucagon S/Es - nausea, headaches - pancreatitis

Answer 78

- injectable S/C - increase incretin effect S/Es -Reduced appetite - Weight loss - GI sx including discomfort, nausea and diarrhoea

Answer 79

- diabetic emergency usually due to inadequate insulin - 3 key features: ketoacidosis, dehydration, potassium imbalance

Answer 80

- liver starts producing ketones to use as fuel - this builds up and kidneys start producing bicarb to counteract ketone acids - over time ketone acids use up bicarb and blood becomes acidotic

Answer 81

- Ketosis and acidosis should have resolved - They should be eating and drinking - They should have started their regular subcutaneous insulin

Answer 82

- pear drop breath - Kussmaul's respiration - reduced LOC - vomiting - abdo pain - dehydration - dry mucous membranes, slow CRT, tachycardia, hypotension

Answer 83

- CBG - hyperglycaemia - ketone - blood ketones > 3 - VBG - acidosis - investigate precipitant e.g. infection (CXR)

Answer 84

all 3 of: 1. Hyperglycaemia (e.g., blood glucose above 11 mmol/L) 2. Ketosis (e.g., blood ketones above 3 mmol/L) 3. Acidosis (e.g., pH below 7.3)

Answer 85

F – Fluids – IV fluid resuscitation with normal saline (e.g., 1 litre in the first hour, followed by 1 litre every 2 hours) I – Insulin – fixed rate insulin infusion (e.g., Actrapid at 0.1 units/kg/hour) G – Glucose – closely monitor blood glucose and add a glucose infusion when it is less than 14 mmol/L P – Potassium – add potassium to IV fluids and monitor closely (e.g., every hour initially) I – Infection – treat underlying triggers such as infection C – Chart fluid balance K – Ketones – monitor blood ketones, pH and bicarbonate

Answer 86

- Hypoglycaemia - Hypokalaemia - Cerebral oedema, particularly in children - Pulmonary oedema secondary to fluid overload or acute respiratory distress syndrome

Answer 87

- rare but potentially fatal complication of type 2 diabetes. - characterised by hyperosmolality (water loss leads to very concentrated blood), high sugar levels (hyperglycaemia) and the absence of ketones, distinguishing it from ketoacidosis

Answer 88

- polyuria - polydipsia - weight loss - dehydration - tachycardia - hypotension - confusion

Answer 89

- CBG - usually hyperglycaemia - serum osmolarity - >320 mOsm/kg - ketones - no ketones - VBG - no sig. acidosis - U+Es - hypo/hypernatraemia, hypo/hyperkalaemia, dehydration - investigate precipitant e.g. septic screen, MI etc

Answer 90

- 0.9% NaCl - 0.5-1l/hr - correct electrolytes - insulin - give if BM stops falling with fluids - LMWH for VTE prophylaxis

Answer 91

EXogenous drugs - insulin, OHAs, alcohol, quinine, quinolones Pituitary insufficiency - no GH/cortisol Liver failure - no glycogen stores Adrenal failure - no cortisol Insulinomas / immune hypoglycaemia Non-pancreatic neoplasms

Answer 92

Adrenergic - sweating, palpitations, tremor, anxiety/irritable, hunger, feel cold Neuroglycopenic - confusion, dizziness, tingling, blurred vision, slurred speech, headache, N+V, seizure, coma - fatigue, weakness

Answer 93

- CBG - ix for cause

Answer 94

- conscious, orientated - oral glucose - conscious, confused, IV access - 100mls 20% / 200mls 10% glucose - conscious, confused, no IV access - 1mg IM glucagon - unconscious / fitting - as above - give long-acting carb on recovery - review meds etc

Answer 95

- high BMs Causes - decompensated / undiagnosed DM - stress - acute illness - Cushing's, pheochromocytoma, acromegaly, hyperthyroidism - meds - eg steroids, BBs

Answer 96

- weakness, headache, blurred vision, polyuria, polydipsia, palpitations, N+V, abdo pain, drowsiness, seizure, coma

Answer 97

- CBG, VBG, bloods, HbA1c

Answer 98

- Novarapid if need to bring down BM - diabetic team review - meds review - tx cause

Answer 99

PTH released from chief cells in 4 parathyroid glands in response to low calcium

Answer 100

1) increases activity and number of osteoclasts in bone causing bone resorption 2) stimulates calcium reabsorption in the kidneys 3) stimulates the kidneys to convert vitamin D3 into calcitriol, the active form of vitamin D - vitamin D promotes calcium absorption from food in intestine net effect = serum calcium increases and serum phosphate decreases

Answer 101

Kidney stones Painful bones Abdominal groans (constipation, nausea and vomiting) Psychiatric moans (fatigue, depression and psychosis)

Answer 102

- excess PTH production from parathyroid tumour -> hypercalcaemia - mostly solitary adenoma, also hyperplasia, multiple adenoma, carcinoma

Answer 103

high PTH high Ca low Phosphate

Answer 104

1. bloods - PTH, calcium, phosphate, ALP 2. urine calcium

Answer 105

- total parathyroidectomy - risk of low Ca / recurrent laryngeal nerve injury - calcimimetic (cinacalcet) - bisphosphonate - alendronate

Answer 106

- insufficient vitamin D or CKD reduces calcium absorption from the intestines, kidneys and bones. - results in low blood calcium - parathyroid glands react to the low serum calcium by excreting more parathyroid hormone

Answer 107

- PTH high - Ca normal (or low) - phosphate high

Answer 108

- Tx cause - vit D replacement, renal transplant - maybe cinacalcet

Answer 109

- occurs after long period of secondary hyperparathyroidism resulting in hyperplasia of PTH glands -> autonomously produce high PTH - high PTH leads to inappropriately high Ca absorption bloods - PTH very high - Ca very high - phosphate high

Answer 110

Low PTH, leading to low Ca

Answer 111

Low PTH due to PT gland failure Causes - acquired / congenital - DiGeorge syndrome - Autoimmune cause - Lack of PT gland at birth - Genetic mutations

Answer 112

- low PTH after damage Causes - physiological - Parathyroidectomy / thyroidectomy (most common) - Radiation - Hypomagnesaemia - Mg required for PTH secretion

Answer 113

- PTH present but body unable to respond to it due to genetic mutations in PTH receptors

Answer 114

- Same phenotypic defects as pseudo- without abnormalities of Ca metabolism

Answer 115

hypocalcaemia signs : trousseau's sign - carpopedal spasm caused by BP cuff chvostek's sign - facial contraction caused by tapping facial nerve hypocalcaemia symptoms: - muscle cramps / pain - fatigue - twitching - paraesthesia - confusion

Answer 116

- bloods - PTH, calcium, phosphate, ALP - test for underlying causes (genetics, auto-antibodies, infection) - test for complications (ECG - see long QT with hypocalcaemia)

Answer 117

Hypo - normal appearance, low PTH, low Ca, high phosph Pseudo - skeletal defects, high PTH, low Ca, high phosph Pseudopseudo - skeletal defects, normal PTH, normal Ca, normal phosph

Answer 118

- IV calcium if severely low - Ca supplements - calcitriol - active vit D

Answer 119

Antidiuretic hormone (ADH) is produced in the hypothalamus and secreted by the posterior pituitary gland aka vasopressin ADH stimulates water reabsorption from the collecting ducts in the kidneys

Answer 120

- Increased secretion by the posterior pituitary - Ectopic ADH, most commonly by small cell lung cancer

Answer 121

- Excessive ADH results in increased water reabsorption in the collecting ducts, diluting the blood - excess water reduces the sodium concentration (hyponatraemia) - extra water is not usually significant enough to cause fluid overload - SIADH results in euvolaemic hyponatraemia

Answer 122

- urine becomes more concentrated as kidneys excrete less water - SO patients with SIADH have high urine osmolality and high urine sodium

Answer 123

- post-operative - SSRIs - small cell lung cancer

Answer 124

- symptoms related to hyponatraemia: - Headache - Fatigue - Muscle aches and cramps - Confusion severe? seizures, low gcs

Answer 125

- excessive water consumption, no cause - euvolaemic hyponatraemia, but low urine Na/osmolality also

Answer 126

- euvolaemic - FBC, U/E - low Na, low serum osmolality - urine studies - high Na, high osmolality >100 - Ix for cause - CXR, CT TAP, short synacthen test, TFTs, serum cortisol

Answer 127

1. Admission if symptomatic or severe (e.g., sodium under 125 mmol/L) 2. Treating the underlying cause (e.g., stopping causative medications or treating the infection) 3. Fluid restriction 4. Vasopressin receptor antagonists (e.g., tolvaptan)

Answer 128

risk of osmotic demyelination syndrome

Answer 129

- lack or production or loss of sensitivity to ADH Cranial DI ' low ADH' = reduced ADH secretion from post pituitary Nephrogenic DI 'insensitivity to ADH' = impaired response of kidney to ADH

Answer 130

- Brain tumours - Brain injury - Brain surgery - Brain infections (e.g., meningitis or encephalitis) - Genetic mutations in the ADH gene (autosomal dominant inheritance) - Wolfram syndrome (a genetic condition also causing optic atrophy, deafness and diabetes mellitus)

Answer 131

- Medications, particularly lithium (used in bipolar affective disorder) - Genetic mutations in the ADH receptor gene (X-linked recessive inheritance) - Hypercalcaemia - Hypokalaemia - Kidney diseases (e.g., polycystic kidney disease)

Answer 132

- polyuria - polydipsia, chronic thirst - nocturia - dehydration - postural hypotension

Answer 133

- urine collection - >3L/24hrs - high/normal serum osmolality - low urine osmolality water deprivation test

Answer 134

used in DI - no water for 8 hours - given desmopressin and measure urine osmolality before and after cranial DI? urine osmolality high nephrogenic DI? urine osmolality low

Answer 135

Cranial DI - oral desmopressin Nephrogenic DI - tx cause - low salt / protein diet - thiazide diuretics - NSAIDs - ibuprofen

Answer 136

- tumour of the adrenal glands that secretes unregulated and excessive amounts of catecholamines (adrenaline) - secrete adrenaline in bursts -> intermittent sx RFx: MEN II, NFT1, von-Hippel-Lindau

Answer 137

- periodic sx - anxiety, sweating, headache, tremor, palpitations, HTN, tachycardia

Answer 138

- plasma free metanephrines - 24hr urine catecholamines - CT / MRI - genetic testing

Answer 139

- alpha blockers - phenoxybenzamine, doxazosin - BBs - partial adrenalectomy

Answer 140

- cancer of thyroid gland - papillary, follicular, anaplastic, lymphoma, medullary cell RFs - radiation exposure - hx of goitre, nodule, thyroiditis, FHx, female, Asian

Answer 141

- thyroid nodule - hard / irregular thyroid - cervical lymphadenopathy - mets to lungs, brain, hepatic, bone - hoarse voice

Answer 142

- fine needle aspiration biopsy / cytology - Bloods - TFTs - US thyroid - thyroglobulin

Answer 143

- papillary / follicular - total thyroidectomy / radioactive iodine - anaplastic / lymphomas - external radiotherapy - medullary - thyroidectomy, lymph node removal - levothyroxine - keep TSH reduced - chemotherapy

Answer 144

dopamine continuously secreted in absence of pregnancy

Answer 145

prolactin will be secreted

Answer 146

1. stimulates milk production 2. inhibits GnRH secretion so inhibits FSh and LH release (they regulate menstruation) --> so during lactation, a period of amenorrhoea will occur NB oxytocin inhibits dopamine so promotes prolactin production

Answer 147

pituitary adenoma secreting prolactin

Answer 148

gynacomastia erectile dysfunction loss of libido galactorrhea NB generic pituitary adenoma too - headaches / bitemporal hemianopia

Answer 149

amenorrhoea galactorrhea infertility NB generic pituitary adenoma too - headaches / bitemporal hemianopia

Answer 150

bloods - GH, prolactin, ACTH, FSH, LH, TFTs MRI head

Answer 151

Medical = dopamine agonist - cabergoline, bromocriptine Surgical = transsphenoidal pituitary resection

Answer 152

- high serum K Classification - Mild - 5.5-5.9 - Moderate - 6.0-6.4 - Severe - >6.5

Answer 153

Renal - AKI, CKD, Addison's, - drugs - spironolactone, ACEi, ARBs, NSAIDs, ciclosporin, heparin Increased circulation of K - exogenous - foods, blood transfusion - endogenous - rhabdo, crush, burns, tumour lysis syndrome IC->EC - DKA, metabolic acidosis - digoxin toxicity, BBs, sux, theophylline Pseudo - haemolysed sample

Answer 154

- asym - Palpitations - Chest pain - Dizzy - Muscle weakness - Stiffness - Fatigue

Answer 155

- VBG, U/E, FBC, LFTs, BMs - serum cortisol / aldosterone if adrenal insufficiency suspected ECG - tall tented T waves - flattened P waves - PR prolongation - broad QRS - sine wave pattern - then VF

Answer 156

- ABCDE - remove cause - calcium gluconate / chloride (if >6.5 / ECG changes) - insulin + dextrose - 10-20 units in 500mls of 10% glucose - salbutamol - furosemide, calcium resonium (GI binder), sodium bicarb, dialysis

Answer 157

serum K<3.5

Answer 158

- not enough K in fluids - GI losses - D+V, malabsorption, laxatives, high output stoma, poor oral intake / inadequate feed - Renal losses - genetic syndromes, Conn's, Cushing's, renal tubular acidosis, furosemide, thiazides - Intracellular shift - alkalosis, insulin, adrenaline, salbutamol

Answer 159

- asym - Muscle weakness - Hypotonia - Hyporeflexia - Tetany - Constipation - Palpitations - Light-headed

Answer 160

- U/E ECG - small / inverted T waves - Long PR - prominent U waves - ST depression - long QT, Torsades de Pointes

Answer 161

- tx cause Mild >3.1 - oral sando-K Severe <3.1 - IV KCl - no quicker than 10mmol/hr - lower - ITU discussion

Answer 162

- normal serum Ca 2.1-2.6 Classification - mild 2.65-3 - asym - moderate - 3.01-3.40 - asym/sx - severe >3.40 - arrhythmias, coma

Answer 163

High/normal PTH - hyperparathyroidism Low PTH - malignancy - SCLC, bone mets, myeloma, ectopic - sarcoidosis, TB - Drugs - Ca/vit D, antacids, thiazides, lithium, theophylline - rhabdo - adrenal insufficiency, thyrotoxicosis, phaeo

Answer 164

Bones - bone pain, fractures, osteopenia, osteomalacia, osteoporosis Stones - renal / biliary stones Groans - abdo pain, pancreatitis, malaise, nausea, constipation, polydipsia, dehydration, confusion Moans - depression, anxiety, cognitive dysfunction, insomnia, coma - sx of malignancy etc

Answer 165

- hydration - Bloods - bone profile, vit D, ALP, U/E - ECG - short QT, brady, 1st HB - CXR, isotope bone scan, CT / MRI - serum ACE (sarcoidosis)

Answer 166

- 0.9% NaCl 4-6l/24hrs - IV bisphosphonates - zolendronate - dialysis - cinacalcet, denosumab, calcitonin, prednisolone

Answer 167

- total thyroidectomy / parathyroidectomy / hypoparathyroid - vit D deficiency - CKD - low Mg (PPIs) - pancreatitis - rhabdo, tumour lysis syndrome - Loop diuretics, steroids, gent, phosphates, theophylline - massive transfusion

Answer 168

SPASMODIC - Spasms - Trousseau's - Perioral paraesthesia - Anxious, irritable, irrational - Seizures - Muscle tone increase in smooth muscle - wheeze - Orientation impaired and confused - Dermatitis - Impetigo herpetiformis - reduced Ca and pustules in pregnancy - Chvostek's sign, cataracts, cardiomyopathy (long QT)

Answer 169

- Bloods - bone profile, U/E, Mg, vit D, PTH, amylase, CK - ECG - prolonged QT

Answer 170

Mild >1.9 - oral sandocal / adcal - vit D - colecalciferol - IV Mg if low - may need calcitriol in para/thyroidectomy Severe <1.9 / sx - cardiac monitor - calcium gluconate bolus / infusion - tx cause

Answer 171

low serum phosph <0.8 (normal 0.8-1.5)

Answer 172

- redistribution into cells - resp alkalosis, insulin, adrenaline - increased urinary excretion - acidosis, DKA, hyperparathyroid - decreased intestinal absorption - antacids, vit D deficiency, D+V, malabsorption - refeeding syndrome - chronic alcohol - acute liver failure

Answer 173

- Asymptomatic - Myopathy, rhabdomyolysis, weakness - Resp failure - Arrhythmias, cardiomyopathy - Irritable, confused, hallucinations, lethargy, seizure, coma - Rickets / osteomalacia if chronic

Answer 174

- bloods - bone profile, Ca, phosph, U/E

Answer 175

- oral phosphate sandoz - IV phosphates polyfusor / sodium glycerophosphate

Answer 176

- low serum Mg (normal 0.7-1.05)

Answer 177

- refeeding syndrome - D+V, high output stoma - alcoholism - hypercalcaemia - SIADH, DKA, aldosteronism - renal losses - post-parathyroidectomy - drugs - diuretics, gent, PPIs

Answer 178

- asym - irritable, lethargy - N+V - confusion, depression, psychosis - tremors, cramps, tetany, weakness, seizures

Answer 179

- ECG - PR prolongation, ST depression, altered T waves, ventricular arrhythmias, eg VF - Bloods - U/E, Ca, Mg - urinary Mg

Answer 180

0.4-0.7 - oral Mg salts <0.4 / tetany, arrhythmias, seizures - IV Mg

Answer 181

- serum Na >145

Answer 182

Hypovolaemic hypernatraemia - salt + water lost, but more water - D+V, sweating, burns, loop diuretics, osmotic diuresis Normovolaemic hypernatraemia - loss of purely water - impaired thirst / water intake -> dehydration - dementia, decreased access to water - diabetes insipidus Hypervolaemic hypernatraemia - rare, iatrogenic - hypertonic saline - hypertonic dialysis - hyperaldosteronism

Answer 183

- Thirst, lethargy, weakness, nausea, loss of appetite - Severe - myoclonic jerks, intracranial haemorrhage, coma, death

Answer 184

- assess fluid status - bloods - U/E, glucose, Mg, Ca - urine / serum osmolalities

Answer 185

- tx cause - oral fluids - 0.9% NaCl (unless hypervolaemic) - correct <0.5mmol/L/hr (cerebral oedema risk)

Answer 186

- low serum Na <135 Severity - Mild – 130-134 - Moderate – 120-129 - Severe – <120

Answer 187

Hypovolaemic hyponatraemia - loss of Na and water - diuretics, Addisonian crisis, D+V, MDMA, pancreatitis - exercise induced hyponatraemia (EAH) Euvolaemic hyponatraemia - volume expansion, no oedema - SIADH - hypothyroidism - beer potomania - adrenal insufficiency Hypervolaemic hyponatraemia - Na and water increase, more water - HF, liver failure, nephrotic syndrome, excessive water consumption

Answer 188

- lab results show low Na, but no hypotonicity - eg glucose - draws water into blood - appears like Na low

Answer 189

- asym early - Headache - Lethargy - N+V - Dizziness - Confusion - Muscle cramps late - seizures - coma - cardio-respiratory arrest

Answer 190

- fluid status - U/E - serum / urine osmolality - urinary sodium - if fluid overloaded - BNP, LFTs, urine dip, protein:creatinine ratio - TFTs, 9am cortisol

Answer 191

Severe sx, Na <120 - HDU / ITU - hypertonic saline - 3% NaCl Hypovolaemic - 0.9% NaCl Euvolaemic - fluid restrict 500-1000ml/d - tolvaptan / demeclocycline Hypervolaemic - fluid restrict 500-1000ml/d - furosemide / tolvaptan

Answer 192

- from rapid over-correction of hyponatraemia - astrocyte/oligodendrocyte apoptosis -> demyelination Px - irreversible sx - dysarthria, dysphagia, paralysis, seizures, confusion - coma - locked-in-syndrome Mx - avoid - Na levels raised by 8mmol/L/24hrs

Answer 193

- autosomal recessive disease of severe hypokalaemia - defective NKCC2 transporter - like lots of furosemide Px - childhood - failure to thrive - polyuria, polydipsia - hypokalaemia - normotension - weakness

Answer 194

- NE tumour derived from pancreatic Islets of Langerhans cells Px - hypoglycaemia - early morning, just after meal - rapid weight gain Ix - high insulin, raised proinsulin:insulin ratio - high c-peptide - supervised prolonged fasting - CT pancreas Mx - surgery - diazoxide / somatostatin

Answer 195

- autosomal dominant - disordered Na channels in distal tubules -> increased Na reabsorption - HTN, hypokalaemic alkalosis Mx amiloride / triamterene

Answer 196

- monogenic diabetes, autosomal dominant inheritance - impaired insulin secretion Px - mild, non-ketotic hyperglycaemia Ix - genetic testing Mx - Sulfonylurea / insulin / nothing depending on type

Answer 197

- autosomal dominant disorders causing different endocrine glands to grow benign, malignant or non cancerous growths

Answer 198

MEN-1 - parathyroid, pituitary, pancreas, adrenal, thyroid - commonly px with hypercalcaemia MEN-2a - medullary thyroid cancer, parathyroid, phaeo MEN-2b - medullary thyroid cancer, phaeo, marfanoid body habitus, neuromas

Answer 199

- abnormal breast tissue in males - increase in oestrogen:androgen ratio Causes - Physiological: normal in puberty - Syndromes with androgen deficiency: Kallman's, Klinefelter's - Testicular failure: e.g. mumps - Liver disease - Testicular cancer e.g. seminoma secreting hCG - Ectopic tumour secretion - Hyperthyroidism - Haemodialysis - Drugs - spironolactone, cimetidine, digoxin, cannabis, finasteride, GnRH agonists, oestrogens, anabolic steroids

Answer 200

- affects 25-50% pts with graves - May be eu/hypo/hyperthyroid - Exophthalmos - Conjunctival oedema - Optic disc swelling - Ophthalmoplegia - Eyelid retraction - Inability to close eyelids -> sore, dry eyes

Answer 201

- stop smoking - topical lubricants - steroids - radiotherapy - surgery Urgent ophthal review if - Unexplained deterioration in vision - Change in colour vision - Hx of eye popping out – globe subluxation - Corneal opacity - Cornea visible when eyelids closed - Disc swelling

Answer 202

Overweight 25 - 30 Obese class 1 30 - 35 Obese class 2 35 - 40 Obese class 3 > 40

Answer 203

conservative: diet, exercise medical - orlistat - liraglutide surgical

Answer 204

a pancreatic lipase inhibitor used in the management of obesity only prescribed for adults as part of a plan who have: - BMI of 28 kg/m^2 or more with associated risk factors, or - BMI of 30 kg/m^2 or more - continued weight loss e.g. 5% at 3 months - orlistat is normally used for < 1 year

Answer 205

- person has a BMI of at least 35 kg/m² - prediabetic hyperglycaemia (e.g. HbA1c 42 - 47 mmol/mol)

Endocrine Flashcards

(232 cards)