ENDOCRINE Flashcards
(107 cards)
1
Q
What does growth hormone do?
A
Increase fat and carbohydrate metabolism as well as causing the liver to make insulin like factors which increase cartilage formation, skeletal growth and increased protein synthesis.
2
Q
What does thyroid hormone do?
A
Creates faster food metabolism (carbohydrates and fat)
More proteins are made
Higher cardiac output
Bone demineralisation
3
Q
What does the adrenal medulla make?
A
Epinephrine and Nor epinephrine
4
Q
What activates the renin-angiotensin system?
A
High blood K+, decreased blood volume and decreased blood pressure
5
Q
What cause aldosterone release and where from?
A
Angiotensin 2
released from the zona glomerulosa of the adrenal cortex
6
Q
What does adlosterone cause?
A
increased Na+ and water absorption but increased K+ excretion
7
Q
Where is atrial natriuretic peptide?
A
The heart
8
Q
What does the liver make?
A
Insulin like growth factor
9
Q
Where is erythropoietin made?
A
The kidneys
10
Q
What allows us to recognise foreign molecules?
A
Major histocompatibility complex
11
Q
What type of hypersensitivity is diabetes?
A
4 and this means T cella attacks the pancreas beta cells
12
Q
What is genes is diabetes linked to?
A
HLA DR3 +4
13
Q
What does polyphagia mean?
A
Excessive hunger
14
Q
What does polydipsia mean?
A
Dehydration
15
Q
What score is done in diabetic patients?
A
Global vascular risk score
16
Q
What is the treatment for diabetic ketoacidosis?
A
Fluids, insulin and electrolytes to replace those lost
17
Q
How does type 2 diabetes occur?
A
The body doesn’t respond to insulin from beta cell as hypertrophy and hyperlasia occurs to make enough insulin but leads to atrophy
18
Q
What is the medical emergency from type 2 diabetes?
A
Hyperosmolar hyperglycaemic
19
Q
Who is type 2 diabetes more common in?
A
Asians and males
20
Q
What are the tests for type 2 diabetes?
A
Hb a1c, fasting gluocse, non-fasting glucose
21
Q
Who should you avoid doing an Hb a1c on?
A
Type 1 diabetes, in pregnancy and children
22
Q
What is the second line treatment for type 2 diabetes?
A
Metformin
23
Q
What is the 3rd line treatment of type 2 diabetes?
A
Metoformin + 1 of: DPP4 inhibitor Pioglitazone Sulphonylurea SGLT-2i
24
Q
What is the 4th line treatment for diabetes?
A
Metformin, usually sulphonylurea and one of the others (DPP4 inhiitor, SGLT-2i or Pioglitazone)
25
Where makes thyroid stimulating hormone?
Anterior pituitary
26
What does thyroid stimulating hormone do?
It causes the thyroid gland to turns thyroglobulin into iodine converting hormones
27
Which of T4 or T3 is active?
T3 is active and T4 is converted from T4
28
What does T3 cause?
Affects cardiac output , bone resorption and activates the sympathetic nervous system
29
What does calcitonin cause?
Lowers blood calcium by inhibiting tubular re-absorption and osteoclasts
30
What mutations are thyroid cancers linked to?
RET and BRAF
31
What do you not see in thyroid cancer?
Hyo or hyper thyroid
32
What are investigations for thyroid cancer?
Check for T4 autoantibodies, chest X-ray, thyroid ultrasound, high calcitonin in medullary
33
What is Cushing's disease?
High cortisol in the blood which is usually removed in the kidney and is caused by a pituitary adenoma.
34
When is the circadian rhythm peak?
In the morning
35
What do delta cells of the pancreas secrete?
Somatostatin
36
Apart from glucose uptake what else does insulin (anabolic hormone) do?
It causes k+ uptake which means it can be used as a treatment for hyperkalaemia
37
What takes glucose into cells?
GLUT receptors
38
What is the pre-diabetic range for HbA1c?
42-47
39
Complications of diabetes?
Retinonapthy, arterial disease, erectile dysfunction, staph. skin infections, foot ulcers and polyneuropathy
40
What are signs of diabetic keto acidosis?
Nausea and vomiting, excessive urine production, dehydration, gradual drowsiness, KUSSMAUL BREATHING
41
What is the treatment for diabetic ketoacidosis?
Fluid restriction using 0.9% saline
Add IV insulin along with usual regime
Assess need for K+ replacement
42
What is the most commonly seen emergency for type 2 diabetes?
Hyperosmolar hyperglyceamic state
43
What signifies a hyperosmolar hyperglycaemic event?
Dehydrtion, hyperglycaemia, altered conciousness and serum osmolarity of >320mOsm/Kg
44
What is the difference between ketoacidosis and hyperglycaemiv hyperosmolar state?
HHS takes longer to develop and does not have ketone production or acidosis. HHS also has a higher mortality rate.
45
How does the thyroid hormone axis work?
The hypothalamus releases thyrotropin- releasing hormone
This makes the anterior pituitary produce thyroid stimulating hormone
Then T4 is released from the tyroid gland which goes to target tissues to become it's active form of T3
46
What is 99% of T3 and T4 bound to in the blood?
Proteins such as thyroxine-binding globulin
47
What is goitre?
A lump in the neck
48
Signs of hyperthyroidism?
Tremor, sweating, restless, wasting, hyperreflexia, palmar erythema, lid retraction
Also see changes on the hands such as clubbing
49
symptoms of hyperthyroidism?
Swaeting, restless, weight loss but increased appetite, heat intolerance, palpitations, diarrhoea, polyuria, irritable
50
Causes of hyperthyroidism?
Grave's disease (most common), toxic multinodular goitre, toxic adenomas, thyroiditis
51
What is the epi of hyperthyroisim?
20-40 and often female
52
What is Grave's disease?
An autoimmune disease from thyroid-stimulating immunoglobulin which causes the thyroid gland to produce excess thyroid hormone.
53
What is the management of hyperthyroidism?
Carbimazole or Proplithiouracil
Radioiodine as most will be hypothyroid after.
Smoking cessation
54
What are the causes of Hypothyroidism?
Hasimoto's thyroiditis
| post surgery for hyperthyrodism, primary atrophic hypothyroidism
55
What are symptoms of hypothyroisim?
Weight gain, cold intolerance, mennorrhagia, fatigue, hoarse voice, constipation, alopecia, carpal tunnel syndrome
56
What are signs of hypothyroisim?
Dry brittle nails, bradycardia, macroglossia, hyporeflexia, alopecia
57
What results appear on investigation for hypothyroidism?
High TSH but low T4
58
What is Hashimoto's thyroiditis?
Lymphocytic infiltration and destruction of the thyroid gland and see Anti-TPO or antithyroglobulin antibodies
59
What is the treatment for hypothyroidism?
Young- Levothyroxine
| Old +IHD- Give in 25mg doses
60
What does vasopressin/ADH do?
It increases expression of aquaporins in the kidney collecting ducts, increasing water retention.
This means lower urine production, higher BP and decreased sweating
61
What increases ADH?
Nicotine, adrenaline,, anaemia, hypovolaemia, hypotension
62
What reduces ADH?
Ethanol, hypertension and alpha adrenergic stimuli
63
What is reduced ADH known as?
Diabetes insipidus
64
What is serum osmolarity?
2(Na+K)+urea+glucose
65
What are features of diabetes insipidus?
Polyuria, Nocturia, compensatory polydipsia, dehydration
66
What can cause diabetes insipidus?
Genes, tumour, infection, renal disease, sickle cell disease or drugs
67
What are the investigations for low ADH?
Osmolality, U+E, 24h urine volumes, Water deprivation test
68
What is the treatment of diabetes insipidus?
Cranial- Desmoprssion
| Nephrogenic- Thiazide diuretics
69
What are the symptoms of SIADH?
Confusion, nausea and irritability but later fits and coma
70
What can cause SIADH?
Tumours, drugs, head injury, alcohol withdrawal, lung diseases
71
What investigations would you do for SIADH?
U+E, Osmolality, urinalysis
72
What is the treatment for SIADH?
Restrict fluid intake, demeoclocycline and tolvaptan
73
What is excess growth hormone in children?
Gigantism (before epiphyseal fusion)
74
What causes acromegaly?
Pituitary ademoma
75
What are the signs of acromegaly?
Large supraorbital ridge, wide nose, macroglossia, spade like hands and feet, tight rings, carpal tunnel
76
What are the symptoms of acromegaly?
Snoring, deep voice, increased sweating, weight and hands/feet, low libido, arthralgia (joint pain) and headacges
77
What are the investigations for acromegaly?
IGF-1, glucose tolerance test, serum calcium, visual fields, MRI, photos
78
What are the expected results for acromegaly?
High gluoce
High calcium
High IGF-1
Pituitary adenoma
79
What is the treatment for acromegaly?
1st- Trans-sphenoidal surgery
2nd- somastatin analogues and/or radiotherapy
3rd- GH antagonist
80
what is Conn's syndrome?
Excess aldosterone production that is independant of the RAA system leading to increased sodium and water retention
81
What will Conn's present with?
It is often asymptomatic but will see signs of low potassium
82
What is the cause of Conn's most commonly?
Aldosterone producing adenoma
83
What is the treatment for Conn's syndrome?
Laparoscopic adrenalectomy with spironolactone given 4 weeks pre op to control K+ and BP
84
What is Cushing's disease?
High levels of cortisol in the blood
85
What is the common cause of Cushing's disease?
Pituitary tumour
86
What are the signs of cushings?
Moon face, central obesity, buffalo neck hump, bruises, muscle atrophy and purple abdo striae
87
What are the symptoms of cushing's?
Increased weight, mood changes, weakness, acne, gonadal dysfunction
88
What are investigations for Cushing's?
High corisol in blood
Overnight dexamethasone suppression test
48hr dexamethasone suppression test
89
Cushing's treatment?
Stop steroids, trans-sphenoidal surgery (cushings), adrenalectomy with radio and mitotane (Adrenal carcinoma), remove tumour and mtyrapone(Ectopic)
90
What is Addison's disease?
Destruction of the entire adrenal cortex and thus affects mineralcorticoids (aldosterone) and glucocorticoids (cortisol) with low sex hormone production.
Caused by TB most commonly world wide but autoimmune adrenalitis in the UK
91
What the symptoms of Addison's?
Anorexia, weight loss, malaise, weakness, fever, depression, syncope, confusion, flu like, dizzy nausea, vomitting, crave salty food
92
What are the signs of Addison's?
Pigmentation, postural hypotension, general wasting, dehydration and alopecia (loss pubic hair)
93
What are the investigations for Addison's disease?
Take a blood sample cortisol and hydrocortisone ACTH stimulation test, morning plasma ACTH
94
What is the treatment of Addison's disease?
1L 0.9% saline and IV hydrocortisone with infused glucose
| Maintenance: prednisolone and fludrocortisone
95
What does parathyroid do?
Controls calcium levels by encouraging bone to release more calcium and the kidneys to reabsorb more calcium and less phosphate
It also creates more active vitamin D to promote vit D absorption
96
How many parathyroid glands do we have?
4
97
What is the managemnt of primary hyperparathyroidism?
Surgery
98
What are test results for hyperparathyroidism?
high calcium
high PTH
low phosphate
high ALP from bone
99
Causes of secondary hyperparathyroidism?
Low vitamin D, malabsorption, CKD and osteomalacia, MALIGNANCY (90% of hypercalcaemia)
100
Signs of hypercalcaemia?
```
STONES
THRONES
GROANS (nausea)
MOANS
PSYCHIATRIC OVERTONES
although very few people will present with this
```
101
What is the treatment for hypercalcaemia?
Treat the underlying cause and correct the calcium levels
102
What are the tests for hypocalcaemia?
Chvostek's sign (tapping nerve creates facial twitching
| Trousseau-
103
What is the management of hypoparathyroid/hypocalcaemia?
EMERGENCY: IV calcium gluconate and cardiac monitoring
104
Causes of Hyperkalaemia?
```
Drugs
Renal failure
Endocrine (Addison's)
Artefact (otherwise well and normal ECG) (most common cause)
DKA
```
105
ECG hyperkalaemia signs?
Widened QRS, prolonged PR intreval, depressed ST segment
106
Hyperkalaemia treatment?
Restrict potassium in diet and hyperkalaemia causing drugs
| Severe- IV calcium gluconate, salbutamol, IV glucose, IV frusemide and saline
107
What are 3 autoantibodies for Grave's disease?
Thyroid stimulating immunoglobulin, antithyroglobulin, anti-thyroid peroxidase
