Endocrine Flashcards
(138 cards)
1
Q
thyroid hormones
- highest
- lowest
A
highest - night
lowest - morning
2
Q
neck lump that moves up on swallowing
A
thyroid goitre
3
Q
neck lump that moves up on swallowing and sticking out tongue
A
thyroglossal cyst
4
Q
branchial cyst presentation
A
large neck swelling on side
teenage years
5
Q
cystic hygroma presentation
A
congenital
large neck swelling
6
Q
orphan annie nuclei
A
papillary thyroid cancer
7
Q
psomomma bodies
A
papillary thyroid cancer
8
Q
spread of papillary thyroid cancer
A
lymphatic
9
Q
spread of papillary follicular cancer
A
haematogenous
10
Q
medullary thyroid ca association
A
MEN IIa or IIb
11
Q
what is medullary thyroid ca
A
ca of parafollicular cells
12
Q
Mx of thyroid ca
A
total thyroidectomy + radio-iodine
13
Q
antibody in graves disease
A
tsh receptor antibody
14
Q
Mx graves for rapid symptom relief
A
propanolol
15
Q
Mx graves
A
carbimazole alone
or
carbimazole + thyroxine (block and replace) for 12-18m then withraw
- radio-iodine
16
Q
drug causing thyrotoxicosis
A
amiodarone
17
Q
antibody in hashimotos thyroiditis
A
anti-TPO antibody
18
Q
subacute de-quervains thyroiditis
A
post-viral with painful goitre
19
Q
progression of subacute de-quervains thyroiditis
A
starts with hyperthyroid – euthyroid – hypothyroid
20
Q
drugs causing hypothyroidism
A
lithium
amiodarone
21
Q
Monitoring primary hypothyroidism
A
TSH
22
Q
Monitoring secondary hypothyroidism
A
T4
23
Q
hormones releases by the anterior pituitary
A
ACTH TSH GH LH FSH Prolactin
24
Q
hormones released by the posterior pituitary
A
Oxytocin
ADH
25
cranial diabetes insipidus
failure of the posterior pituitary to release ADH
26
causes of cranial diabetes insipidus
idiopathic
neoplasm
post-surgery
trauma
27
wolfram's syndrome
'DIDMOAD'
Diabetes Insipidus
Diabetes Mellitus
Optic Atrophy
Deafness
28
nephrogenic diabetes insipidus
failure of the kidneys to respond to ADH
29
causes of nephrogenic diabetes insipidus
genetic
electrolyte abnormalities -
hypercalcaemia, hypokalaemia
drugs - lithium
30
drug that causes nephrogenic diabetes insipidus
lithium
31
presentation diabetes insipidus
polyuria (large volumes of dilute urine)
| polydipsia
32
Ix diabetes insipidus
plasma osmolality - high
urine osmolality - low
water deprivation test - will continue to pee ++ volumes
33
Mx cranial diabetes insipidus
Desmopressin (synthetic analogue of ADH)
34
what is a 'non-functioning' pituitary adenoma
doesn't secrete active hormones
35
classification of non-functioning pituitary adenoma
micro-adenoma = <1cm
macro-adenoma = >1cm
36
presentation of a non-functioning pituitary adenoma
```
headache
worsening visual acuity
double vision
panhypopituitarism
CN palsies - III, IV, VI compression
bitemporal hemianopia
```
37
Ix pituitary adenoma
1. pituitary blood profile
| 2. MRI brain with contrast
38
Mx pituitary adenoma
observation
| surgical removal - transsphenoidal approach, post op XRT
39
what are the 2 most common hormones to be secreted by a pituitary adenoma
prolactin (prolactinoma)
| GH (acromegaly)
40
presentation of a prolactinoma
Females:
- amenorrhoea
- infertility
- galactorrhoea
- reduced libido
- wt gain
Males:
- erectile dysfunction
- reduced facial hair
- osteoporosis
- galactorrhoea
41
Mx prolactinoma
Dopamine Agonists:
- bromocriptine
- cabergoline
42
presentation of acromegaly
```
coarse facial hair
large hands
increase in shoe size
excessive sweating
macroglossia
acanthosis nigricans
```
43
what genetic condition is associated with acromegaly
MEN I
44
Ix acromegaly
1. IGF-1 levels
- if raised,
2. Oral Glucose Tolerance Test (OGTT)
- give 75g oral glucose, take level a 0, 30, 0, 90, 120, 150mins
- GH normally inhibited by hyperglycaemia
- if raised,
3. MRI brain with contrast
45
Mx acromegaly
1. surgical removal (trans-sphenoidal approach)
2. somatostatin analogues (inhibit GH) - octreotide
3. GH antagonists - pegvisomat
46
HbA1c level
- normal
- diabetes diagnosis
normal = <41 mmol/L
diabetes = >48 mmol/L
47
Fasting glucose level
- normal
- diabetes diagnosis
normal = <6 mmol/L
diabetes = >7 mmol/L
48
2hr OGTT level
- normal
- diabetes diagnosis
normal = < 7.7 mmol/L
diabetes = > 11.1 mmol/L
49
Random glucose level
- normal
- diabetes diagnosis
normal = < 7.7. mmol/L
diabetes = > 11.1 mmol/L
50
Ix T1DM
1. random blood glucose
2. fasting blood glucose
3. HbA1c
4. 2h OGTT
51
rapid acting insulins
novorapid
| Humalog
52
short-acting insulins
actrapid
Humulin S
insuman rapid
53
intermediate acting insulins
Humulin I
Insulatard
Insuman Basal
54
long acting insulins
Lantus
| Levemir
55
how much insulin in total should someone be taking a day
0.2 - 0.4 units/kg/day
56
what is a basal bolus regime
basal = 1/2 of the total daily dose of insulin is taken before bed
bolus = 1/2 of the total daily dose of insulin is split over meal times
57
what is Latent Autoimmune Diabetes of Adulthood
autoimmune diabetes that develops in an older person and is often misdiagnosed as having T2DM
58
presentation of LADA
young adult 25-40
non-obese
auto ab +ve
non-insulin requiring at diagnosis
59
Ix T2DM
1. random blood glucose
2. fasting blood glucose
3. HbA1c
4. 2h OGTT
60
metformin - class of drug
biguanide
61
biguanides - mode of action
improve sensitivity to insulin
62
benefits of biguanides
no hypo risk
CVS benefits
weight reduction
safe in preg
63
s/e of biguanides
GI upset
| lactic acidosis
64
glicazide - class of drug
sulphonylurea
65
sulphonylureas - mode of action
promote insulin release from islet cells
66
benefits of sulphonylureas
quick reduction in hyperglycaemia
67
s/e of sulphonylureas
hypo risk
weight gain
no CVS benefits
68
dapagliflozin - class of drug
SGLT2 inhibitors
69
SGLT2 inhibitors - mode of action
enhance glucose excretion by the kidney
70
benefits of SGLT2 inhibitors
no hypo risk
wt loss
CVs benefits
71
s/e of SGLT2 inhibitors
increased thrush and urine infections
72
pioglitazone - class of drug
TZDs (PPARy agonists)
73
TZDs - mode of action
promote glucose uptake
74
s/e of TZDs
weight gain
fluid retention
increased risk of hip # in elderly
75
sitagliptin - class of drug
DPP-IV inhibitors (gliptans)
76
DPP-IV inhibitors - mode of action
act on the incretin pathway
77
s/e of DPP-IV inhibitors
no CVS benefits
low/mod efficacy
weight neutral
78
exenatide - class of drug
GLP -1 agonist
79
GLP-1 agonists - mode of action
acts on the incretin pathway
80
benefits of GLP -1 agonists
SC injection
wt loss
low hypo risk
81
s/e of GLP -1 agonist
nausea
| pancreatitis
82
Mx of T2DM
1. Lifestyle
2. Metformin
3. + sulphonylurea OR SGLT-2 inhibitor OR DPP inhibitor OR TZD
4. + one of the above or injectable
83
what is maturity onset diabetes of the young (MODY)
familial form of early onset T2DM
84
types of MODY
glucokinase (GCK)
transcription factor
85
presentation of MODY
strong FHx
renal cysts
GAD -ve
c-peptide +ve
86
Mx MODY
GCK MODY - no Tx
Transcription Factor MODY - sulphonylurea
87
what is the hallmark of diabetic nephropathy
proteinuria
88
Ix of diabetic nephropathy
urinary albumin : creatinine ratio
89
normal urinary albumin : creatinine ratio
Males < 2.5
| Females < 3.5
90
Mx diabetic nephropathy
ACEi
91
Mx DKA
1. fluid replacement (most are depleted 5-8 litres)
2. Insulin infusion (0.1 unit/kg/hr)
3. start 5% dextrose infusion when BG <15mmol/L
4. correct hypokalaemia (caused by the insulin)
92
What do you do with a T1DM insulin when they are being treated for DKA
continue their basal insulin, omit bolus insulin
93
pathogenesis of hyperosmolar hyperglycaemic state (HHS)
```
hyperglycaemia -
osmotic diuresis -
loss of Na + K -
increase serum osmolality -
increase hyperviscosity of blood
```
94
Mx HHS
1. Fluid Replacement - 0.9% saline IVI over 48h
if ketotic - give insulin
95
mild hypoglycaemia
- presentation
- Mx
pt conscious, orientated, able to swallow
Mx = 15-20g of quick acting carbohydrate
96
moderate hypoglycaemia
- presentation
- Mx
pt conscious, able to swallow, disorientated/confused
Mx = 1.5-2 tubes of glucose gel squeezed into mouth between teeth and gums
97
severe hypoglycaemia
- presentation
- Mx
pt unconscious, fitting, very aggressive or NBM
Mx = IV glucose 150ml 10% or 75ml 20%
98
causes of primary hyperparathyroidism
solitary adenoma (80%)
hyperplasia of glands
parathyroid Ca
genetic (MEN)
99
biochem primary hyperparathyroidism
PTH - raised
Ca - raised
Phosphate - low
Alk phos - high
100
Mx primary hyperparathyroidism
surgical candidate:
parathyroidectomy
non-surgical candidate:
monitoring + bisphosphonates
101
causes of secondary hyperparathyroidism
this is a physiological response to a low Ca
- chronic renal failure
- vitamin D deficiency
102
biochem secondary hyperparathyroidism
PTH - raised (appropriately)
| Ca - low
103
cause of tertiary hyperparathyroidism
hyperplastic change to the parathyroid glands -
| the parathyroid becomes autonomous after many years of secondary hyperparathyroidism
104
biochem tertiary hyperparathyroidism
PTH - raised ++ (inappropriately)
| Ca - raised
105
what is familial benign hypocalciuric hypercalcaemia
autosomal dominant defect in Ca sensing
106
presentation of hypoparathyroidism
related to low Ca
'SPASMODIC'
```
Spasms
Paraesthesiae
Anxious
Seizures
Muscle tone increase
Orientation confused
Impetigo Herpetiformis
Chvostek's sign
```
107
Mx primary hypoparathyroidism
oral Ca supplements + calcitriol
108
pseudohypoparathyroidism
genetic condition
- failure of target cells to respond to PTH
- high PTH, low Ca
109
pseudopseudohypoparathyroidism biochem
normal biochem!
110
secretions of the renal cortex
Glomerulosa - Mineralocorticoids
Fasiculata - Glucocorticoids
Reticularis - Sex Steroids
111
what stimulates glucorticoid release from the adrenal cortex
ACTH
112
what stimulates mineralocorticoid release from the adrenal cortex
RAAS system
113
what stimulates sex steroid release from the adrenal cortex
ACTH
114
secretions of the renal medulla
catecholamines (adrenaline)
115
what is addisons disease
primary hypoadrenalism - low cortisol and aldosterone
116
presentation of addisons disease
```
ski pigmentation + buccal mucosa ("bronze diabetes")
abdo pain
fatigue
vomiting
diarrhoea
low BP
```
117
Ix for Addisons
short syacthen test
- give 250mcg IM synthetic ACTH
- measure cortisol before and 30mins after
- if cortisol stays low = Addison's
118
Mx Addisons
replace the cortisol = hydrocortisone, dexamethasone or prednisolone
replace the aldosterone = fludrocortisone
119
what is cushings syndrome
the clinical state caused by excess cortisol
120
causes of cushings syndrome
ACTH dependent causes:
- cushings diease (ACTH secreting pituitary adenoma)
- ectopic ACTH (small cell lung cancer)
ACTH independent causes:
- adrenal tumours
- steroids
121
screening tests for cushings syndrome
1. Overnight dexamethasone suppression test
- give dexa 1mg at night, measure cortisol at 8am
2. 24h urinary free cortisol
122
diagnostic test for cushings syndrome
48h dexamethasone suppression
123
conn's syndrome
aldosterone producing adenoma - the most common cause of hyperaldosteronism
124
presentation hyperaldosteronism
- HTN
- hypokalaemia
(main ones to be aware of)
- nocturia
- polyuria
- lethargy
- mood disturbance
125
screening tests for hyperaldosteronism
```
plasma K (low)
aldosterone/renin ratio (raised)
```
126
Ix for Conn's syndrome
1. fludrocortisone suppression test
| 2. high res CT abdo
127
Mx conn's syndrome
unilateral tumour - laparoscopic adrenalectomy
bilateral tumour - aldosterone antagonists (spironolactone)
128
presentation of phaechromocytoma
episodic headache
sweating
tachycardia
+/- high BP
129
Ix phaeochromocytoma
1. bloods - plasma metanephrine levels
| 2. CT & MRI
130
Mx phaechromocytoma
```
1. alpha blockade (doxazosin, prazosin)
THEN
beta blockade (atenolol, propranolol)
```
2. surgical excision
131
Mx gynaecomastia
address underlying cause
surgery (cosmetic)
anti-oestrogens (tamoxifen)
132
causes of hypoglycaemia in a non-diabetic patient
'EXPLAIN'
```
EX = Exogenous drugs - alcohol, quinine sulfate, ACEi, aspirin poisoining
P = pituitary insuffiency
L = liver failure
A = Addison's disease
I = islet cell tumours e.g. insulinoma
N = non=pancreatic neoplasms
```
133
most important modifiable risk factor in the development of thyroid eye disease
smoking
134
T2DM BP target with no end organ damage
< 140/80 mmHg
135
T2DM BP target with end organ damage
< 130/80 mmHg
136
Mx of intercurrent illness in a person with Addison's
double their hydrocortisone dose
137
triad of renal cell carcinoma
haematuria
abdominal mass
loin pain
138
Mx renal cell carcinoma
radical nephrectomy
