Endocrine Flashcards by Belle Storey

Most common cause of acromegaly

Excess growth hormone secondary to a pituitary adenoma (95% of cases)

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State 6 signs or symptoms in acromegaly

Spade-like hands
Increase in shoe size
Large tongue, interdental spaces
Excessive sweating and oily skin
Headaches
Bitemporal heminanopia
Galactorrhoea

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What causes the visual field defect in acromegaly?

Pituitary adenoma on the optic chiasm

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What serum blood test do you want to perform to screen for acromegaly?

Serum insulin like growth factor 1 (IGF-1)

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Explain how an OGTT can aid the diagnosis of acromegaly

Hyperglycaemia causes NO suppression of GH after OGTT

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What other endocrinological disorder would you screen for in acromegaly?

Diabetes mellitus

GH is an anti-insulin

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What is the main cause of death in acromegaly patients

Cardiovascular disease

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What surgery is performed to cure acromegaly in 95% of patients

Trans-sphenoidal surgery

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Name 3 drugs that can cause hypothyroidism

Carbimazole
Lithium
Amiodarone

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Name 4 signs and symptoms of hypothyroidism

Symptoms:
Weight gain
Lethargy
Cold intolerance
Constipation
Menorrhagia

Signs:
Dry, cold, yellowish skin
Non-pitting oedema
Dry, coarse scalp hair
Decreased reflexes

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Other than iatrogenic, name 4 causes of hypothyroidism

Hashimoto
Iodine deficiency
Radioactive iodine
Thyroid surgery

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What might a FBC show in hypothyroidism

Macrocytic anaemia

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What will the level of TSH and T4 be in a patient with primary hypothyroidism

High TSH, low T4

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How would you treat hypothyroidism medically

Levothyroxine

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A patient with hypothyroidism notices white patches on the back of both of her hands - what could this represent?

Vitiligo

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What anatomical structure represents the site at which the thyroid gland originated before embryological descent

Foramen caecum

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What is Grave’s disease

Autoimmune condition causing hyperthyroidism caused by IgG antibodies to the TSH receptor (TSH receptor stimulating antibodies and anti-thyroid peroxidase antibodies)

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Name 3 specific signs of Grave’s disease

Exophthalmos
Opthalmoplegia (Lid retraction, lid lag)
Pretibial myxedema
Acropachy / soft tissue swelling and clubbing of the fingers and toe

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What would thyroid scintigraphy show in Graves’ disease

diffuse, homogenous, increased uptake of radioactive iodine

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What drug class can control tremor in hyperthyroidism

Beta blocker

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Name 1 drugs used in hyperthyroidism

Carbimazole

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Other than Grave’s specific signs, name 3 signs of hyperthyroidism

Fine tremor
Palmar erythema / warm, sweaty hands
Tachycardia
Atrial fibrillation

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Excessive thirst, weight loss and increased urine production

Urine dipstick negative for glucose

Most likely diagnosis?

Diabetes insipidus

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Where is ADH secreted from?

Posterior pituitary

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Diabetes insipidus Urine osmolality? Plasma osmolality?

Urine osmolality: low (very diluted) Plasma osmolality: high (very concentrated) or normal (because of the excess water drinking)

Whats the difference between nephrogenic and cranial diabetes insipidus?

Cranial: lack of ADH production Nephrogenic: lack of response to ADH

How is the water deprivation test used to diagnose diabetes insipidus and what is the differential

The differential is primary polydipsia Water deprivation test: DI will continue to have low urine osmolality PP will have high urine osmolality after water deprivation

Name 1 drug used to treat the cranial type of this condition

Desmopressin

A woman recently gave birth and suffered a massive post-partum haemorrhage. She is now suffering from diabetes insipidus. What is the likely cause?

Sheehan's syndrome (pituitary gland infarction)

3 causes of hypoglycaemia

Insulinoma Self-administration of insulin Alcohol (causes exagerrated insulin secretion)

Name 4 autonomic symptoms of hypoglycaemia

Sweating Shaking Hunger Anxiety Nausea

Likely cause of hypoglycaemia in an unconscious teenage boy with known diabetes

Inappropriate use of insulin (overmedicating)

Name 2 symptoms of neuroglycopenia other than coma

Weakness Vision changes Confusion Dizziness

What can repeated episodes of hypoglycaemia lead to?

A lack of awareness of hypoglycaemia happening

What advice would you give to a patient and their family regarding prevention of hypoglycaemic episodes

Regular meals (never miss one) Regular finger-prick monitoring Keep emergency supply of glucose in pocket e.g. energy tablets Adjust insulin appropriately in response to change in diet, activity or illness

Middle aged man complaining of persistent fungal infection in penis, tiredness, visual blurring and polyuria. What is the underlying diagnosis?

T2DM

Explain the OGTT

Plasma glucose 2h after drinking 75g glucose

Name 2 macrovascular complications and 2 microvascular complications of T2DM

Macrovascular: Stroke CVD Microvascular: Retinopathy Neuropathy Nephropathy

Other than Metformin, name 3 agents that could be used to treat T2DM

Sulfonyureas Pioglitazone DPP4 inhibitors SGLT2 inhibitors GLP-1 analogue

How do you confirm the diagnosis of DKA by bedside testing

Urinary ketones

Name 2 venous blood tests you may perform for the causes of DKA

FBC (infection) U&E (electrolyte abnormality, renal failure)

pH 7.11 PO2 13.8 PCO2 2.7 BE -7.3 HCO3 18.9 What in your interpretation of this ABG?

Metabolic acidosis with respiratory compensation

What is the management of DKA?

Fluids Insulin Glucose when < 14 Potassium in IV fluids Investigate and treat underlying cause e.g. infection Chart fluids Ketones, pH, bicarb

Explain the pathophysiology of DKA and the 3 most common precipitating factors

Uncontrolled lipolysis which results in excess free fatty acids ultimately converted to ketone bodies Infection Missed insulin doses Myocardial infarction

Middle aged man with fatigue and loss of appetite, slight tanning of the skin and buccal pigmentation. PMH of vitiligo. Most likely diagnosis?

Addison's disease

Pathophysiology of Addison's disease

Autoimmune destruction of the adrenal glands resulting in reduced cortisol and aldosterone

Name 2 tests you would like to perform to aid the diagnosis of Addison's disease

Diagnostic: ACTH stimulation test (short SynACTHen test) plasma cortisol is measured before and after 30 minutes after giving SynACTHen IM If this test is not available, 9am serum cortisol >100 should prompt further synacthen test U&Es for electrolyte abnormalities

What would a U&E show in Addison's disease

No aldosterone = hyponatraemia, hyperkalaemia No cortisol = hypoglycaemia Metabolic acidosis

Apart from glucocorticoids (hydrocortisone), what drug class would you prescribe in Addison's disease

mineralocorticoids (fludrocortisone)

Give 3 pieces of advice you would provide after prescribing glucocorticoids to a patient

Carry a steroid card and medic alert ID bracelet Double the dose during acute illness Do not miss a dose Carry emergency IM hydrocortisone

What is the commonest cause of pathological hyperprolactinaemia?

Prolactinoma (pituitary adenoma)

Name 3 signs or symptoms a patient with hyperprolactinaemia may have?

Galactorrhoea Subfertility Decreased libido Headache Bitemporal hemianopia

What imaging test would you request in hyperprolactinaemia

MRI head

Name a drug used to treat hyperprolactinaemia and its mechanism of action

Cabergoline/bromocriptine (dopamine agonist)

Other than pharmacological, what other treatment is available to a patient with hyperprolactinaemia who refuses surgery

Radiotherapy

Commonest cause of primary hyperparathyroidism

Solitary adenoma (80%)

Name 4 signs or symptoms of hypercalcaemia

Bones, stones, groans and psychiatric moans Shortened QT interval on ECG

In primary hyperparathyroidism, will the a) calcium and b) phosphate be low/normal/high

High calcium Low phosphate *PTH may be inappropriately normal with the raised calcium as it should be low due to negative feedback*

In secondary hyperparathyroidism, will the a) calcium and b) phosphate be low/normal/high

Low or normal calcium Elevated phosphate

In tertiary hyperparathyroidism, will the a) calcium and b) phosphate be low/normal/high

Normal or high calcium Normal or decreased phosphate

What imaging test would you order in primary hyperparathyroidism?

X-ray shows pepperpot skull

Definitive management of primary parathyroidism

Total parathyroidectomy Complication: laryngeal nerve palsy

What is the relationship between vitamin D and calcium?

vitamin D levels increase the efficiency of calcium absorption in the gut

What type of sense diminishes first in peripheral neuropathy?

Vibration

Other than glove and stocking neuropathy, what signs may you find on diabetic foot examination

Charcot's joint (neuropathic arthropathy) Painless ulcer High arched foot with clawing of toes Diminished reflexes

Name 2 other types of neuropathy that occur in diabetes patients

Autonomic neuropathy Diabetic amytrophy Mononeuritis multiplex

What is key in management of preventing progression of polyneuropathy

good glycaemic control

A man with T2DM and peripheral neuropathy has intractable vomiting, what is the likely cause?

Autonomic gastroparesis

Most serious side effect of carbimazole and signs that would alert a patient to it

Agranulocytosis Seek medical advice if sore throat, mouth ulcers, bruising, fever, malaise

2 definitive management options for Grave's disease

Radioiodine therapy Thyroidectomy

Part of adrenal gland and hormone

Zona glomerulosa: aldosterone Zona fasciculata: cortisol Zona reticularis: androgens Medulla: adrenaline

2 signs and 2 symptoms of Cushing's

Symptoms: depression, insomnia, acne Signs: moon face, buffalo hump, central obesity

Blood test and time for overnight suppression test

Serum cortisol 9am

Diagnostic criteria for DKA

D: Glucose >11 or known DM K: Ketones >3 or urinary ketones ++ A: pH <7.3 Bicarbonate <15

Insulin rate for DKA

0.1 units / kg / hour

ABG complication of fluid overload

Hyperchloraemic metabolic acidosis

List 3 initial steps in the management of unrousable hypoglycaemia after 1 dose of glucose IV

Another dose of IV glucose Oxygen Collateral history Bloods lab glucose Urea and electrolytes

What underlying problem might explain hypoglycaemia in a T2DM on insulin

Excess insulin Intercurrent illness Reduced oral intake

Possible safeguarding concern in hypoglycaemia in a insulin dependent patient and how to test it

Excess exogenous insulin either by carer, family or self Test by measuring c-peptide (measure of endogenous insulin only)

3 nephrogenic causes of DI

Genetic ADH receptor abnormality Lithium Haemochromatosis

Why do polyuria and polydipsia occur in hyperglycaemia

Water is dragged out of the body due to the osmotic effects of excess blood glucose being secreted in the urine

2 causes for 90% of hypercalcaemia

Primary hyperparathyroidism Malignancy (PTHrP from tumour e.g. SCC, bone mets, myeloma)

Endocrine Flashcards

(82 cards)