Endocrine Flashcards
1
Q
Calcium is important in functioning of
A
Nerves and muscles (such as the heart)
2
Q
Hypocalcaemia
A
Low serum albumin = low total serum calcium
3
Q
Consequences of hypocalcaemia
A
Parasthesia (pins and needles) Muscle spasm - hands and feet Seizures Basal ganglia calcification Cataracts ECG abnormalities - Long QT interval (and vice versa for hypercalcaemia)
4
Q
Key signs of hypocalcemia
A
Chvostecks sign - spasm of facial muscles after tapping over the facial nerve
5
Q
Causes of hypocalcemia
A
VitD deficiency
6
Q
Vitamin D deficiency
A
Secondary hyperparathyroidism
Raised PTH
Low Ca
Low phosphate
7
Q
Hypoparathyroidism
A
Low PTH
Low Ca
Raised phosphate
8
Q
Pseudohypoparathyroidism
A
Resistance to PTH
Classic sign - Short fourth metacarpals
9
Q
Pseudohypoparathyroidism
A
Raised PTH
Low Ca
Raised phosphate
10
Q
Pseudopseudohypoparathyroidism
A
Normal Ca metabolism (normal PTH, Ca, phosphate)
However, pseudo phenotype symptoms present
11
Q
Hypercalcaemia symptoms
A
Thirst, polyuria Nausea Constipation Confusion (leads to coma) Renal stones ECG abnormalities - Short QT
12
Q
Hypercalcaemia - Causes
A
Malignancy - bone mets, myeloma
Primary hyperparathyroidism
13
Q
Hypercalcaemia
A
Low PTH
Raised Ca
Variable phosphate
14
Q
Primary hyperparathyroidism - Consequences
A
Bones - osteoporosis
Stones - kidney
Groans - confusion
Moans - constipation
15
Q
Primary hyperparathyroidism - Main cause
A
Single benign adenoma
16
Q
Primary hyperparathyroidism
A
Raised PTH
Raised Ca
Low phosphate
17
Q
Tertiary hyperparathyroidism
A
Renal failure - can’t activate VitD, leads to VitD deficiency
18
Q
Tertiary hyperparathyroidism
A
Raised PTH
Raised Ca
Raised phosphate
19
Q
Diabetes mellitus
A
Disorder of carb metabolism characterised by hyperglycaemia
20
Q
Diabetes - Serious complications
A
Diabetic retinopathy Diabetic nephropathy Stroke CVD Diabetic neuropathy
21
Q
Diabetes - Types
A
Type 1 Type 2 - includes gestational and medication-induced MODY Pancreatic diabetes Endocrine diabetes - acromegaly/cushings Malnutrition related diabetes
22
Q
Cortisol - glucose relationship
A
Raised cortisol = raised glucose
23
Q
Diabetes definition
A
Symptoms and random plasma glucose above a set threshold
24
Q
Type 1 diabetes - pathogenesis
A
Insulin deficiency characterised by loss of beta cells due to autoimmune destruction
Beta cells express antigens of HLA histocompatibility system perhaps in response to an environmental event such as virus or initiated by genetic susceptibility
Activates a chronic cell-mediated immune process leading to chronic ‘insulitis’
Increased cortisol and adrenaline on top of this leads to ultimate progressive catabolic state and increasing levels of ketones
25
Type 2 diabetes - Aetiology
Impaired insulin secretion
Insulin resistance
Progressive hyperglycaemia and high free fatty acids
Fat (free fatty acids) deposits back into pancreatic beta cells which drives this cycle further
Lipid deposition in liver and pancreas leads to both insulin resistance and impaired insulin secretion
26
Type 2 diabetes - Treatment
Weight loss and exercise if substantial will reverse hyperglycaemia
Medication to control BP, blood glucose and lipids
27
Insulin types
Basal insulin
| Meal-time insulin/prandial insulin (rapid-acting analogues)
28
T2DM
Earlier insulin initiation is needed
29
Human premixed 70/30 insulin
70% long acting
| 30% short-acting
30
Basal insulin - Pros and cons
Pros - less risk of hypoglycaemia at night
| Cons - Doesn't cover meals
31
Premixed insulin - Pros and cons
Pros - Both basal and prandial components in a single insulin preparation
Cons - Requires strict and consistent meal/exercise patterns
32
T1DM
Basal-bolus insulin therapy is the gold standard treatment (long and short-acting combo)
33
Hypoglycaemia
Low plasma glucose causing impaired brain function - neuroglycopenia
34
Hypoglycaemia - symptoms
```
Palpitations
Sweating
Confusion
Dizziness
Weakness
Nausea
Headache
```
35
Hypoglycaemia - Risk factors
Advancing age
| Renal impairment
36
Hypoglycaemia - Consequences
Seizures
Cognitive dysfunction
CVD
37
Pituitary-thyroid axis
Hypothalamus - (TRH) - pituitary - (TSH) - thyroid - (T4+T3)
T4 is converted to T3 which is the activated form
T4 contains 4 iodine molecules whereas T3 only 3
38
Pituitary-gonadal axis
Hypothalamus - Pituitary - Testosterone - Sperm
| Inactive pituitary in females results in lack of periods (amenorrhea)
39
HPA (Hypo-Pit-Adrenal) axis
Hypothalamus - Pituitary - ACTH - Adrenal - Cortisol
40
Growth hormone/IGF1 axis
Hypo - (GHRH + SMS) - Pit - (GH) - Liver - (IGF1)
41
Dopamine
Hypo - (Dopamine) - Pituitary
Prolactin raised if dopamine inhibited
Prolactin important in breast milk production
42
Hypothalamus hormones
```
GHRH and SMS
GnRH
CRH
TRH
Dopamine
```
43
Pituitary hormones
```
GH
LH and FSH
ACTH
TSH
Prolactin
```
44
Pituitary diseases
```
Benign pituitary adenoma
Craniopharyngioma
Trauma
Apoplexy (pituitary bleed causing expansion and local compression)/sheehans
Sarcoid/TB
```
45
Tumours cause
Pressure on local structure (optics nerves - bitemporal hemianopia (both outer visual fields are blocked, centre fields are fine))
Pressure on normal pituitary (hypopituitarism)
Functioning tumor - Too much hormone released (Cushing's, prolactinoma, acromegaly/gigantism)
46
Hypopituitarism presentation
Pale
No body hair
Central obesity
47
Cushing's syndrome
Raised cortisol (leads to immunosuppression and infections)
Raised glucocorticoid
Excess fat which leads to weight loss very strangely
Redistribution of fat and muscle wasting
In adults, can get bruising and recurrent ulcers/infections
48
Cushing's syndrome
Fat - increased and redistributed (weight gain, central obesity, moon face, buffalo hump, fat pads)
Protein - catabolism (muscle wasting, weakness, thin skin, striae, bruising)
Androgenic effects - Acne
49
Cushing's syndrome - Definition
Chronic, excessive and inappropriate elevated levels of circulating plasma glucocorticoids (cortisol)
50
Cushing's syndrome - Causes
Tumour of the pituitary gland (ACTH-dependent)
Tumour of another organ (lungs) (ACTH-dependent)
Adrenal tumour (ACTH-independent)
51
Cushing's syndrome - Female to male ratio
Female>Male
52
Cushing's syndrome - Clinical features
```
Carb - diabetes
Eelctrolyte - Hypertension
Immune suppression
Central - Malaise, depressioon
Suppressed gonadal function - amenhorrea
```
53
Cushings - Diagnosis
1 - Cushing's syndrome
| 2 - Cause (ACTH dependent or independent)
54
Cushing's syndrome - Screening
Urinary free cortisol
Low dose dexamethasone suppression tests
Late night/midnight serum or salivary cortisol
55
Cushing's syndrome vs disease
When the ACTH comes from the pituitary gland it is called Cushing's disease
56
Confirming Cushing's syndrome
Measure plasma ACTH
Low plasma ACTH - Adrenal CT - Lesion (adenoma)
Raised plasma ACTH - Pituitary MRI/ CT/MRI thorax/abdo
57
Cushing's syndrome - Management
Surgery
| Radiotherapy
58
Acromegaly - Pathogenesis
Growth hormone-secreting pituitary tumour
IGF1 released at liver
Body enlargement (increased height, tissues - hands, feet, jaw)
59
Acromegaly - Comorbidities
```
Hypertension/CVD
Headache
Arthritis
Diabetes
Sleep apnea
```
60
Acromegaly - Diagnosis
Clinical features
GH
IGF1
61
Acromegaly - Clinical features
```
Acral enlargement
Arthralgias (aches and pains)
Maxillofacial changes
Excessive sweating
Headache
Hypogonadal symptoms
```
62
Acromegaly - Diagnostic test
Glucose tolerance test
63
Acromegaly - Treatment
```
Pituitary surgery (decompression)
Radiotherapy
```
64
Microadenomas vs macroadenomas
Cure rate after surgery is higher for microadenomas
65
Pituitary surgery - Complications
Diabetes insipidus
| Hypopituitarism
66
Stereotactic Radiotherapy
Single fraction
| Less radiation to surrounding tissues
67
Medical therapy
Dopamine agonists - Cabergoline
Somatostatin analogues
GH receptor antagonist
68
Dopamine agonists
Cabergoline
Control GH and IGF1
Oral admin
Rapid onset
69
Somatostatin analogues
Octreotide
Injection once monthly
Controls GH and IGF1
70
Pegvisomant
GH analogue
SC admin
Prevents GH binding at liver (inhibits IGF1 production)
71
Prolactinoma - Female to male ratio
F>M
72
Prolactinoma - Pathogenesis
Lactotroph cell tumour of the pituitary
73
Prolactinoma - Clinical features
```
Galactorrhoea
Headache
Bitemporal hemianopia
CSF leak
Menstrual irregularity/amenorrhea
Infertility
Low testosterone in men
```
74
Prolactinoma - Management
Medical rather than surgical
| Dopmaine agonists - Cabergoline
75
Prolactinoma - Summary
Cause of infertility and hypogonadism
| Galactorrhea
76
Cortisol circadian rhythm
Cortisol secretion patterns
Rise at early morning
Peak during morning
Fall during afternoon
Metabolic problems arise when this rhythm is disrupted
Liver expects low levels at night times so if disrupted then liver presents metabolic problems
Higher cortisol levels keep you awake and vice versa
Body clock - The sleep/wake cycle
77
Superchisasmatic nuclei in eye
Central clock controls peripheral clocks
| Glucocorticoids are the secondary messenger from central to peripheral clocks (organs)
78
Addison's disease
Primary adrenal insufficiency - Low cortisol
Autoimmune adrenalitis
Vitiligo - autoimmune lack of melanin in the skin
Weight loss
Infection (TB)
79
Adrenal insufficiency
Primary - Addison's disease
Secondary - Hypopituitarism (Cranio apoplexy, infection, mets, pituitary macroadenoma)
Tertiary - Suppression of HPA (Steroids, oral, inhaler, creams)
80
Adrenal insufficiency - Diagnosis
Symptoms - Weight loss, fatigue, headache, steroid history, TB, cancer, postpartum bleed, autoimmunity
Signs - Pigmentation and pallor, hypotension, Low Na
81
Adrenal insufficiency - Investigation
Biochemical - Cortisol and ACTH tests at 9am
| Synacthen test
82
Adrenal insufficiency - Investigation causes
Primary - Adrenal antibodies
| Secondary - Steroids
83
Adrenal insufficiency - Treatment
Hydrocortisone (synthetic cortisol) - replace cortisol levels
Fluids
84
Thyroid autoantibodies found in autoimmune hypothyroidism
```
Thyroglobulin
Thyroid peroxidase (TPO)
```
85
Mechanism of thyroid cell destruction
Cytotoxic T cell-mediated
| Thyroid autoantibodies may cause secondary damage
86
Graves disease - TSH receptor antibodies
Thyroid-stimulating antibodies cause Graves
Hyperthyroidism - Graves (stimulating TSH receptor)
Hypothyroidism - Myxoedema (blocking TSH receptor)
87
Thyroid autoimmunity - Risk factors
F>M (sex hormones - oestrogen)
Genetic
Environmental - stress, high iodine intake, smoking
88
Autoimmune diseases associated with thyroid autoimmunity
```
T1DM
Addison's
Pernicious anemia
Vitiligo
RA
SLE
Sjogren's syndrome
Chronic active hepatitis
```
89
Thyroid associated ophthalmopathy
```
Present in most Graves and some autoimmune hypothyroidism
Periorbital oedema (swelling in extraocular muscles)
Glycosaminoglycans are released which trap water and cause oedema which results in swelling
```
90
Neonatal Graves
Graves disease is caused by thyroid stimulating antibodies that may cross the placenta and cause neonatal graves
91
GOITRE
Palpable and visible thyroid enlargement
| endemic in iodine-deficient areas
92
Sporadic non-toxic GOITRE
Commonest endocrine disorder
| Thyroid enlargement
93
Hyperthyroidism
Excess of thyroid hormones in the blood
94
Hyperthyroidism - 3 mechanisms of increased levels
Overproduction of thyroid hormone
Leakage of preformed hormone from the thyroid
Ingestion of excess thyroid hormone
95
Hyperthyroidism - Causes
Graves
Multinodular GOITRE
Toxic adenoma
96
All forms of thyroiditis increase levels of thyroid hormones by
Leakage
97
Drug-induced hyperthyroidism
Iodine
| Amiodarone
98
Hyperthyroidism - Clinical features (everything goes up)
```
Wt loss
Tachycardia
Hyperphagia
Tremor
Sweating
Diarrhoea
Menstrual disturbance
```
99
Hyperthyroidism - Investigations
```
Thyroid function tests (Raised free T3 and T4, suppressed TSH)
Clinical history
Physical signs
Thyroid antibodies
Isotope uptake scan
```
100
Primary vs secondary hyperthyroidism
Primary hyperthyroidism - (Raised free T3 and T4, suppressed TSH)
Secondary hyperthyroidism - (Raised free T3 and T4, Raised TSH)
101
Hyperthyroidism - Treatment
Antithyroid drugs (Thionamides)- Carbimazole (decreases synthesis of thyroid hormone), PTU (inhibit the conversion of T4-T3)
Radioiodine
Surgery (partial, subtotal thyroidectomy)
102
Thionamides - Side effects
Rash
Arthralgia
Hepatitis
Thrombocytopenia
103
Iodine
Essential for thyroid hormone production
| Actively transported by NA/I symporter into thyroid follicular cells
104
Surgery
Graves - whole
| Adenoma - partial
105
Hypothyroidism
Primary - Absent from birth/dysfunction, Hashimoto's thyroiditis
Secondary - Pituitary dysfunction
Tertiary - Hypothalamic dysfunction
106
Hypothyroidism - Drug causes
Iodine
| Amiodarone
107
Neonatal hypothyroidism
Thyroid ectopia
| Resistance to thyroid hormone
108
Hypothyroidism - Clinical features
```
Fatigue
Wt gain
Constipation
Menstrual disturbance
Oedema
Muscle cramps
```
109
Hypothyroidism - Investigation
Thyroid function test
110
Hypothyroidism - Thyroid function test results
Primary - Raised TSH, normal T4, low T3
| Secondary/Tertiary - Low TSH, reduced T4/T3
111
Hypothyroidism - Treatment
Synthetic L-Thyroxine (T4)
112
Pregnancy - Metabolic changes
```
Increased erythropoietin, cortisol and noradrenaline
High cardiac output
Plasma volume expansion
High cholesterol
Pro thrombotic and inflammatory state
Insulin resistance
```
113
Pregnancy - Gestational syndromes
Gestational diabetes
Postpartum thyroiditis
Lipid disorders
114
Derbyshire neck
GOITRE
115
Glycoprotein hormones
TSH
LH
FSH
Beta HCG
116
Hypothyroidism in pregnancy
```
Gestational hypertension
Placental abruption
Low birth weight
Neonatal GOITRE
Neonatal resp distress
Postpartum haemorrhage
```
117
Antithyroid drugs can cause in severe cases
Agranular cytosis
118
TSHR autoantibodies
TRAB/TBII
119
Drugs which disrupt thyroid function
Amiodarone
| Interferon
120
Amiodarone
```
Iodine rich
Treats arrhythmias (AF)
```
121
Interferon
Anti-cancer drug
122
Vasopressin
Aka ADH
Made in hypo, released from the posterior pituitary
Binds to G protein-coupled 7 transmembrane domain receptors
Aquaporin molecules are inserted which allow reabsorption of water
V1a - Vasculature
V2 - Renal collecting tubules
V1b - Pituitary
Release controlled by - Osmoreceptors in the hypothalamus - day to day, Baroreceptors in the brainstem and great vessels - emergency
123
Posterior pituitary diseases
Lack of vasopressin - Cranial diabetes insipidus
Resistance to action of vasopressin - Nephrogenic diabetes insipidus
Too much vasopressin release when it shouldn't be released - Syndrome of anti-diuretic hormone secretion (SIADH)
124
Diabetes insipidus
Inappropriate dilute urine for plasma osmolality
Polyuria
Polydypsia
No glycosuria
Diagnosis - Measure urine volume, check renal function and serum calcium
125
Anterior pituitary tumours do not cause
Diabetes insipidus
126
Nephrogenic diabetes insipidus - Causes
Genetic
Chronic renal impairment
Meabolic - Hypercalcemia
127
Cranial diabetes insipidus - Causes
```
Tumours (mets)
Trauma
Infection (TB, encephalitis, meningitis)
Infarction
Genetic
```
128
Desmopressin
A synthetic analogue of vasopressin
129
Diabetes insipidus - Diagnostic tests
Water deprivation test
| Copeptin
130
Cranial DI - Treatment
Desmopressin (Activates V2 receptor)
131
Nephrogenic DI - Treatment
V high dose of desmopressin
| Otherwise difficult to treat
132
Hyponatraemia
Tends to be due to excess water rather than salt loss
133
Hyponatraemia - Signs and symptoms
```
Headache
N&V
Confusion
Convulsions
Unstable gait - falls
```
134
Hyponatraemia - Diagnostic tests and treatment
Urinary Na
TFT
Cortisol levels
Check whether dehydrated or not (then either give saline or restrict fluids to balance levels)
135
Liver cirrhosis causes
Fluid retention (overload)
136
SIADH
Syndrome of inappropriate antidiuretic hormone secretion
137
SIADH - Causes
CNS - Head trauma, meningitis, encephalitis, tumour, abscess
| Drug effects
138
SIADH - Treatment
Fluid restriction
| Vaptan - V2 receptor antagonist (oral)
139
Osmotic demyelination syndrome
Death of the pons (brainstem) leading to brain cell dysfunction
Destruction of the myelin sheath covering nerve cells in the pons of the brainstem
140
Pituitary mass lesions
```
Non-functioning pituitary adenomas
Endocrine active pituitary adenomas
Malignant pituitary tumours (functional and non-functional pituitary carcinoma)
Mets in the pituitary (breast, lung, stomach, kidney)
Pituitary cysts (Rathke's cleft cyst)
```
141
Anterior vs posterior pituitary tissue
Anterior pituitary - Glandular tissue
| Posterior pituiatary - Nerve tissue
142
Craniopharyngioma
Arises from remnants of Rathke's pouch
Can be calcified
Solid and cystic
Raised ICP, visual disturbances, pituitary hormone deficiency
143
Rathke's cyst
Derived from remnants of rathke's pouch
Mostly small
Headache, amenorrhea, hydrocephalus, hypopituitarism
144
Meningioma
Complication of radiotherapy
| Visual disturbance and endocrine dysfunction
145
Lymphocytic hypophysitis
Inflammation of pituitary gland due to an autoimmune reaction
Common in women - pregnancy/postpartum
Stalk and pituitary enlargement
146
Non-functioning pituitary adenoma
Visual disturbances
Headaches
Trans-sphenoidal surgery if threatening eyesight or showing signs of aggression (increasing size)
147
Testing pituitary function
Hormones
Circadian rhythms
If peripheral target organ is working normally then pituitary is normal
148
Testing pituitary-thyroid axis
TSH and Ft4 (Free T4) levels are key determinants
Primary hypothyroid - Raised TSH, Low Ft4
Hypopituitary - Normal/Low TSH, Low Ft4
Graves disease - Suppressed TSH, HIigh Ft4
TSHoma - Normal/High TSH, High Ft4
Hormone resistance - Normal/High TSH, High Ft4
149
Testing gonadal axis in men
Testosterone (T) levels and LH/FSH
Primary hypogonadism - Low T, raised LH/FSH
Hypopituiary - Low T, Normal/Low LH/FSH
Anabolic use - Low T, Suppressed LH
150
Testing gonadal axis in women
Before puberty - Oestradiol low/undeetctable, Low LH/fsh
Puberty - Raised LH/Oestradiol
Post-menarche - Menstrual cycle with everything raised
Primary ovarian failure (menopause) - High LH/FSH, Low oestradiol
Hypopituitary - Low oestradiol, Normal/Low LH/FSH
151
Testing HPA axis
Circadian rhythm - Measure cortisol at 9am
Primary adrenal insufficiency - Low cortisol, high ACTH
Hypopituitarism - Low cortisol, Low/normal ACTH
152
Testing GH/IGF1 axis
GH is secreted in pulses with greatest pulse at night
GH levels fall with age and are low in obesity
Measure IGF1 and GH - Glucagon test, Insulin stress test
153
Measuring prolactin levels
Prolactin is a stress hormone
| Prolactin may be raised because of stress, prolactinoma
154
Diabetes insipidus - Test
Water deprivation test
155
Key tests
Dexamethasone suppression testing – Cushing’s
Oral glucose GH suppression test - Acromegaly
CRH stimulation – Cushing’s
TRH stimulation – TSHoma
GnRH stimulation – gonadotrophin deficiency
Insulin-induced hypoglycemia – GH/ACTH deficiency
Glucagon test – GH deficiency
156
Treating pituitary hormone deficiencies
```
GH - Growth hormone
LH/FSH - Testosterone (M) or Oestradiol+progesterone (F)
TSH - Levothyroxine
ACTH - Hydrocortisone
ADH - Desmopressin
```
157
Radiological evaluation
MRI (Preferred for pituitary imaging) - Soft tissues/vasculature
CT - Bony/calcified structures
158
Testosterone replacement
Improves libido, energy levels and wellbeing
159
Oestrogen replacement
Oral or combined with progesterone
| Improves vaginal atrophy
160
Diabetes - Presenting features
Thirst
Polyuria
Weight loss - due to gluconeogenesis
Fatigue
Hunger
Pruritus vulvae/Balanitis (vaginal candidiasis, chest infections)
Blurred vision (altered acuity due to uptake of glucose and water into lens)
161
Type 1 - Suggestive features
Childhood-onset
Lean body habitus
Prone to ketoacidosis
High levels of islet autoantibodies
162
Presentation depends on
Rate of Beta cell destruction
163
Type 1 diabetes - Clinical features of newly diagnosed
A short history of severe symptoms
Weight loss
Large urinary ketones
164
T2D - Suggestive features
Gradual onset
100% concordance in identical twins
Lifestyle often can control it, insulin may be required later in disease
165
T1 vs T2
T2 - Younger patients, weight loss+ketouria
| T1 - Obese
166
If in doubt with diagnosing diabetes, treat with
Insulin
167
Ketoacidosis
Absence of insulin and rising counteregulatory homrones leads to increasing hyperlgycaemia and rising ketones
Glucose and ketones escape in the urine and lead to an omsotic diuresis and falling circulating blood volume
Ketones (weak organic acids) cause anorexia and vomiting
Vicous cycle of increasing dehhydration and hyperglycaemia
168
Diabetic ketoacidosis
Hyperglycaemia
Raised plasma ketones
Metabolic acidosis (Raised plasma bicarbonate)
169
Diabetic ketoacidosis - Triad of
Hyperglycamia
Ketones
Acidosis
170
DKA - Symptoms
```
Polyuria
Polydipsia
N&V
Wt loss
Abdo pain
Confusion/drowsiness
```
171
DKA - Signs
```
Hyperventilation
Dehydration
Hypotension
Tachycardia
Coma
```
172
DKA - Management
Firstly, Rehydration - Fluids (dilutes acid and glucose)
Secondly, Insulin (Stops new ketone production and glucose production)
Thirdly, Electrolyte replacement (K)
173
DKA - Complications
```
Cerebral oedema
Resp distress syndrome
Thromboemolism - Venous and arterial
Aspiration pneumonia
Death
```
174
Aims of treatment in T1D
Prevent ketoacidosis
| Prevent microvascular and macrovascular complications
175
Microvascular complications
Nephropathy
Retinopathy
Neuropathy
176
T1D - Treatment
Insulin - Twice daily mixture, Basal bolus
177
Glucose monitoring with insulin intake
Blood glucose meters and pens
178
T1 VS T2
T1 more difficult to control than T2
179
Hypoglycaemia - Symptoms
```
Shaking
Fast heartbeat
Sweating
Dizziness
Anxious
Hunger
Impaired vision
Weakness
Fatigue
```
180
Acute deprivation of glucose within the brain leads to
Cerebral dysfunction (loss of concentration, confusion, coma)
181
Physiological defences to hypoglycaemia
Release of adrenaline and glucagon
| Symptoms - autonomic and neuro
182
Insulin pumps
T1D
| Continuous infusion of insulin as opposed to carrying a pen or injection
183
Insulin and weight
Tend to gain weight
184
MODY - Maturity-onset diabetes of the young
Autosomal dom
Non-insulin dependent
Single gene defect altering beta-cell function
Tend to be non-obese
MODY is typically misdiagnosed as T1D or young-onset T2D
185
Permanent neonatal diabetes
Diagnosed less than 6 months old
Signs - small babies, epilepsy, muscle weakness
Treatment - Sulfonylureas
186
MIDD - Maternally inherited diabetes and deafness
Mutation in mitochondrial DNA
Loss of beta-cell mass
Similar presentation to T2D
Wide phenotype
187
Lipodystrophy
Selective loss of adipose tissue
| Associated with insulin resistance
188
Exocrine pancreas - Diseases
Inflammatory - Acute (hyperglycaemia)
Chronic pancreatitis - Alcohol
Hereditary haemochromatosis - Auto rec (Triad of cirrhosis, diabetes and bronzed hyperpigmentation due to excess iron deposition)
Deposition - Amyloidosis, cystinosis
Pancreatic neoplasia - Loss of glucagon function means prone to hypo. Require SC insulin
Cystic fibrosis - CTFR (CF Transmembrane conductance regulator) regulates chloride secretion, viscous secretions lead to duct obstruction and fibrosis, Insulin treatment required
189
Insulin improves cystic fibrosis quality of life by
Improving bodyweight, reduces infections, lung function
190
Endocrine causes of diabetes
Acromegaly - Excess GH secretion, insulin resistance rises which impairs insulin action
Cushing's syndrome - Excess glucocorticoids increase insulin resistance
191
Drug-induced diabetes
Thiazides
Antipsychotics
Protease inhibitors (HIV treatment)
192
Hyperthyroidism - Presentation
```
Head - Anxiety, heat intolerance (hot)
Eyes - Bulging
Mouth - Increased appetite
Neck - GOITRE (Bulging)
Chest - Tachycardia
Hands - Tremor, clubbing, sweating
Abdo - Weight loss, diarrhoea
```
193
Hypothyroidism - Presentation
```
Head - Cold intolerance (cold)
Face - Blank expression
Mouth - Decreased appetite
Chest - Bradycardia
Hands - Brittle nails
Abdo - Weight gain
```
194
Cancer
Weight Loss
195
Hyperkalemia
Arrhythmias and death
196
TSH raised
High T4 - Pituitary problem
| Low T4 - Thyroid problem
197
TSH low
High T4 - Thyroid problem
| Low T4 - Pituitary problem
198
T4 and T3
T4 - Thyroxine
| T3 - Triiodothyronine
199
Addison's disease
Autoimmune attack of adrenal gland
Tanned
Tired
Tearful
200
Long term steroids can lead to
Adrenal insufficiency (Addison's disease)
201
3 Functions of parathyroid hormone
To increase blood calcium from bone resorption
Kidney reabsorption of Ca
Increased gut absorption of Ca
202
Hypercalcaemia
Bones
Groans (Abdo)
Stones (Renal)
Moans (Pysch)
203
Bisphosphonates
Hypercalcemia
