Endocrine

Question 1

What 3 hormones do the adrenals produce

Answer 1

Glucocorticoids cortisol
Mineralcorticoids aldosterone
Sex hormones

Question 2

Where does aldosterone work

Answer 2

Distal convoluted table → reabsorb Na through Na/K pump.

Stimulates loss of protons and reabsorb Bicarb

Question 3

Therefore in addisonian rises what abnormalities would you see on ABG

Answer 3

metabolic acidosis (can't get rid of acid and reabsorb bicarb)
↓Na, ↑K

Question 4

Lack of cortisol causes what serum abnormality

Answer 4

↓glucose

Question 5

Why do you get mucosal skin pigmentation

Answer 5

ACTH and MTH made from same precursor (refer to osmosis video)

Question 6

Mgmt of addisonian crisis

Answer 6

1. Measure cortisol
2. IM hydro 100mg
3. 1L 0.9 NaCL over 1 hour

Question 7

Most common cause of adrenal insufficiency

Answer 7

autoimmune destruction (80%)

Question 8

What is the defining test for addisons?

Answer 8

Synacthen Test - give

Question 9

What is Waterhouse Freidrichsen Sybdrome

Answer 9

Actue haemorrhage of adrenal glands → secondary to meningococcal septicaemia

Question 10

What is Sheehans syndrome

Answer 10

Hypopitutarism cause by ischchaemic necrosis after blood loss in childbirth

Question 11

Signs of hypokalaemia on ECG

Answer 11

T wave inversion

U waves → looks wavy google it

Question 12

To types of adrenal ↑

Answer 12

1. Cushing syndrome

2. Primary hyperaldostonism

Question 13

Cushing signs

Answer 13

Muscle wasting + thin extremities, DM, easy bruising …..

Question 14

Causes of cushings syndrome

Answer 14

1. ACTH dependant
   • Cushings disease (80%) - pituitary tumour secreting ACTH
   • ectopic ACTH production - small cell lung cancer

ACTH Indépendant causes

1) Iatrogenic: steroid
2) adrenal adenoma (5-10%)

Question 15

Primary hyperaldosteronism 2 causes?

Answer 15

1) Adrenal adenoma (conns syndrome) → cut it out or spironolactone
2) bilateral idiopathic adrenal hyperplasia

Question 16

Long term steroid mgmt.

1) what to do in infections
2) D+V

Answer 16

1) ↑ during infection - double dose

2) IV or IM dose

Question 17

Why give 
fludrocortisone 
Hydrocortison
prednisolone 
Dexamethasone

Answer 17

1) ↓ glucocortisone, ↑ mineral corticoid

4) ↑ glucocorticoid, ↓ mineralcorticoid

Question 18

What is a pheochromocytoma?

Answer 18

Catecholamine secreting tumour

Question 19

Investigations for pheochromocytoma

Answer 19

24 hours collection of urinary metanephrines

Question 20

Tx for pheochromocytoma? What medication must you give before?

Answer 20

Surgery give alpha blocker before

Question 21

Main causes of hypercalcaemia

Answer 21

1) Primary hyperparathyroidism

2) Malignancy

Question 22

How can malignancy cause hypercalcaemia

Answer 22

bone mets
myeloma
PTHrP from squamous cell lung cancer

Question 23

Mgmt of hypercalcaemia

Answer 23

• Fluids resus

* Bisphosphanates → take 2-4 days to work.

Question 24

What is trousseaus?

Answer 24

BP cuff sign

Question 25

What can you see in ECG on hypocalcaemia

Answer 25

prolonged QT interval

Question 26

Signs of hypocalaemia

Answer 26

CATs go Numb confusion arrhythmia tetany numbness

Question 27

Causes of hypocalcaemia

Answer 27

1. vit D deficiency (osteomalcai) 2. Chronic renal failure 3. hypoparathyroidism (e.g. post thyroid/parathyroid surgery)

Question 28

What is the relationship between Ca and phospahte

Answer 28

PTH 1) ↑ osteoclasts - ↑Ca ↑phos 2) Kidney → activates vit D 3) At nephron PTH causes >Ca and < phosphate → net ↑CA ↓phosphate

Question 29

What 4 markers help you differentiate causes of hypocalcaemia

Answer 29

Calcium Phosphate ALP PTH go through table lifted form pass medicine

Question 30

Refeeding Syndrome → what causes it, what electrolytes deplete Who can it effect

Answer 30

↓ phos, Ca, Mg - all low in cells but normal in serum People who have not been eating - e.g bowel surgery, anorexia

Question 31

Why does hypercalcaemia cause polyuria

Answer 31

Nephrogenic diabetes inscipidous - stops nephron reacting to ADH

Question 32

ADH - where produced and why?

Answer 32

Produced posterior pit release in response to ↓ plasma volume,

Question 33

ADH - where produced and why?

Answer 33

Produced posterior pit release in response to ↓ plasma volume, ↑drum osmolarity

Question 34

Why thirsty when hungover

Answer 34

Prevents pituitary releasing ADH - central diabetes incipidous

Question 35

What is nephrogenic DI

Answer 35

insensitivity to ADH | lithitum, hypercalcaemia, Demeclomyclin

Question 36

Central DI

Answer 36

Deficiency of ADH | head injury

Question 37

Inv of diabetes insipidus

Answer 37

• High plasma osmolality, low • urine osmolality Water deprivation test - deprive of water and measure conc of urine → unable to concentrate urine then give synthetic ADN (vasoopressin) - >

Question 38

How to test of central of nephrogenic

Answer 38

``` synthetic ADN (vasoopressin) - > if central will concentrate urine → nephro will stay the same ```

Question 39

What is nephrogenic DI

Answer 39

insensitivity to ADH lithitum, hypercalcaemia, Demeclomyclin → polyuria and extreme thirst

Question 40

Causes

Answer 40

Small cell lung cancer Any neuro injury SSRI, tricyclic

Question 41

Mgmt

Answer 41

Fluid restriction → 1 L a day | Demeclomcycline

Question 42

Hyponatraemia symtoms

Answer 42

Muscle weakness spasms/cramps Seizures + feeling crap

Question 43

How to work out cause

Answer 43

1) Fluid balance examination | 2) urine osmolarity

Question 44

If hypovolaemia and urine osmorlity < 20

Answer 44

D+V, sweating, burn

Question 45

If hypervolaemia and urine osmorlity < 20

Answer 45

HF, cirrhosis, IV dex

Question 46

If hypovolaemia and urine osmorlity > 20

Answer 46

Diuretics, addisons,

Question 47

If euvolaemic and urine osmorlity > 20

Answer 47

SIADH

Question 48

If correct hyponatraemia too quickly what happens, how quickly should you fix it

Answer 48

central pontine myelinolysis 10mmol/day - 0.9% NaCl - 8 hourly

Question 49

What do you give for prolactinoma

Answer 49

Dompaine agnoist - bromocriptine ↑ dopamine ↓ prolactin

Question 50

Test for acromegaly

Answer 50

glucose tolerance test → high glucose, suppresses pituitary