Endocrine Flashcards by Kitty Acton

What hormones are released by the anterior pituitary?

LH/FSH 
GH
TSH
Prolactin
ACTH

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What hormones are released by the posterior pituitary?

Vasopressin

Oxytocin

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Where do paracrine, autocrine and endocrine hormones act?

Paracrine - nearby cells
Autocrine - cells of origin
Endocrine - distant site

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What are the microvascular and macrovascular complications of DM?

Micro - retinopathy, nephropathy, neuropathy

Macro - stroke, MI, renovascular disease, limb ischaemia

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What are some atypical causes of DM?

Steroids, anti-HIV drugs, antipsychotics
Pancreatitis, trauma, CF, cancer
Cushing’s - acromegaly, phaechromocytoma, hyperthyroidism, pregnancy

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What are the criteria for impaired glucose tolerance?

OGTT >7.8mmol/L

DM = >11.1mmol/L

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What are the criteria for impaired fasting glucose?

Impaired = >6.1mmol/L 
DM = >7mmol/L

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What is metabolic syndrome?

2 of:

BP >130/85
Triglycerides >1.7mmol/L
Fasting glucose >5.6mmol/L or T2DM

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What are the features of metformin?

Biguanide drug, increases insulin sensitivity
Helps with weight loss
SE: nausea, diarrhoea, abdo pain

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What are some features of DPP4 inhibitors?

Inhibit enzymes that breakdown incretin (hormone that decreases blood glucose)
e.g. Sitagliptin

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What are some features of glitazone?

Increases insulin sensitivity

SE: hypoglycaemia, fractures, fluid retention, abnormal LFTs

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What are some features of sulphonyureas?

Increase insulin secretion
e.g. gliclazide
SE: hypoglycaemia, weight gain

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What are some features of SGLT inhibitors?

Blocks reabsorption of glucose in the kidneys

e.g. empagliflozin

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What are the stages of diabetic retinopathy?

Background - micro aneurysms, haemorrhages, exudates
Pre-proliferative - cotton wool spots, haemorrhages
Proliferative - new vessel formation

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What are the different types of diabetic neuropathy?

Symmetrical sensory polyneuropathy
Mononeuritis multiplex
Amyotrophy - painful wasting of quads and pelvic muscles
Autonomic neuropathy - postural BP drop, gastroparesis, urine retention, ED, diarrhoea

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What is the triad of diabetic ketoacidosis?

Acidaemia
Hyperglycaemia >11
Ketonaemia or ketonuria

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What is the management of DKA?

ABCDE
Cannulae and fluid bolus
VBG, glucose, ketones, UEs, FBC, CRP
50 units insuline in 50ml saline
Check glucose and ketones hourly
Find and treat cause

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What are non-DM causes of hypoglycaemia?

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EXogenous drugs
Pituitary insufficiency 
Liver failure
Addison's 
Islet cell tumours 
Non-pancreatic neoplasms

What are some signs of hyperthyroidism?

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Tachycardia, AF, tremor, palmar erythema
Thin hair, lid lag
Goitre, nodule, bruit

Graves - exophthalmos, ophthalmoplegia, pre-tibial myxoedema, clubbing

What are some causes of hyperthyroidism?

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Graves
Toxic multi nodular goitre 
Toxic adenoma 
Ectopic thyroid tissue - ovarian teratoma 
Idoine excess 
De-Quervian's thyroiditis 
Amiodarone, lithium 
Post-partum

What are the signs of hypothyroidism?

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Ascites, weight gain
Pallor, puffy lids, coarse hair
Ataxia, hyporeflexia

What are some causes of hypothyroidism?

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Hashimoto’s thyroiditis
Iodine deficiency
Post-thyroidectomy
Amiodarone, lithium

What is the action of PTH?

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Secreted in response in decreased Ca levels
Increases osteoclast activity
Ca and phosphate released from bones
Increased Ca and decreased phosphate reabsorption in the kidney

Net = increased calcium, decreased phosphate

What are the causes and features of primary hyperparathyroidism?

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80% caused by solitary adenoma
All gland hyperplasia

Hypercalcaemia - weak, tired, depressed, thirsty, renal stones
Bone reabsorption - pain, fractures, osteoporosis
Hypertension

What are the causes of secondary hyperparathyroidism?

Low vitamin D, chronic renal failure - low calcium

What is the cause of tertiary hyperparathyroidism?

Occurs after prolonged secondary due to gland hyperplasia | High calcium, high PTH - no negative feedback

What are the causes and signs of primary hypoparathyroidism?

Autoimmune, Di George ``` Spasms Paraesthesia Anxiety Seizures Muscle tone increased Orientation impairment Dermatitis Impetigo Cardiomyopathy ```

What are the causes of secondary hypoparathyroidism?

Radiation, surgery, hypomagnesaemia

What is multiple endocrine neoplasia?

Functioning hormone-producing tumours in multiple organs Autosomal dominant Includes: MEN 1 and 2, neurofibromatosis, Von-hippel Lindau and Peutz Jegher

What is the tumour pattern in MEN1?

Parathyroid adenoma Pancreas insulinoma or gastronoma Pituitary prolactinoma MEN1 = tumour suppressor gene

What is the tumour pattern in MEN2?

A - Thyroid medullary carcinoma, phaeochromocytoma, parathyroid hyperplasia B - similar to A, + mucosal neuromas and Marfinoid appearance, - hyperparathyroidism MEN2 = oncogene

What does the adrenal cortex produce?

1. Glucocorticoids e.g. cortisol 2. Mineralocorticoids e.g. aldosterone 3. Androgens

What are some ACTH dependent causes of Cushing's syndrome?

Cushing's disease i.e. pituitary adenoma | Ectopic ACTH production e.g. SC lung cancer, carcinoid tumours

What are some ACTH independent causes of Cushing's syndrome?

Iatrogenic - taking steroids Adrenal adenoma/carcinoma Adrenal hyperplasia McCune-Albright syndrome

What are some symptoms of Cushing's syndrome?

Weight gain, acne, proximal weakness Depression, irritability, lethargy, psychosis Irregular menses, hirtuism, erectile dysfunction

What are some signs of Cushing's syndrome?

Central obesity Bruises, purple abdominal striae Osteoporosis, hypertension, hyperglycaemia, frequent infections

What initial investigation should be done for Cushing's syndrome?

1. Overnight dexamethasone suppression test - 1mg dex at midnight - Measure cortisol at 8am - Normally suppresses to <50nmol/L

What are the next line tests for Cushing's syndrome?

2. 48 hour dexamethasone suppression test 3. Plasma ACTH - If undetectable think adrenal tumour - CT - If detectable do high dose suppression test 4. MRI pituitary 5. Bilateral inferior petrosal sinus blood sampling

What are the causes of primary adrenal insufficiency (Addison's)?

Autoimmune | TB, lymphoma, APS, SLE

What is Waterhouse-Freiderichsen syndrome?

Bilateral adrenal cortex haemorrhage in meningococcal sepsis

What causes secondary adrenal insufficiency?

Suppression of the pituitary adrenal axis from chronic steroid use

What are the signs and symptoms of Addison's?

Lean, tanned, tired, tearful, weak, anorexia, faints, dizziness Depression, psychosis Nausea and vomiting, abdominal pain, diarrhoea or constipation Pigmented palmar creases and buccal mucosa Postural hypotension

What investigations should be done for Addison's?

U and Es | Low sodium, high potassium

Endocrine Flashcards

(43 cards)