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Endocrine Flashcards

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1
Q

Hypocalcaemia

- Aetiology

A 
H - Hypoparathyroidism 
A - Acute pancreatitis 
      Alkalosis
V - Vit D deficiency 
O - Osteomalacia 
C - CKD
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2
Q

Hypocalcaemia

- Sx

A 
S - Spasms 
P - 
A - Anxiety 
S - Seizures 
M - Increased muscle tone
O - Orientation impaired and confusion
D - Dermatitis 
I - Impetigo hepatiformis 
C - Chvosteck sign

Trousseau sign

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3
Q

Hypocalcaemia

- Investigations and Tx

A

ECG - Long QT

tx - Adcal

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4
Q

Hypercalcaemia

- why mis-diagnosed

A
  • Tourniquet on for too long

- old sample that has haemolysed

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5
Q

Hypercalcaemia

- Aetiology

A

-Primary hyperparathyroidism
- Malignancy
Myeloma and non-hodgkin
Tumous –> PTHrP
- Thiazide diuretics

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6
Q

HYpercalcaemia

- Sx

A

Bones, Stones, Abdo moans,Psychic groans

Bones - Increased risk of fractures
Stones - Kidney stones
Abdo gorans - Constipation, Indigestions, vomitting, Nausea
Psychic groans - Depression, Anxiety, Memory loss

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7
Q

Hypercalcaemia

Investigations and tx

A

-Investigations
Corrected calcium levle s
PTH
U+E

  • Tx
  • Saline
  • Bisphosphonates
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8
Q

T1DM Risk factors

A
  • Family hx
  • HLA DR3/DR4
  • Finnish
  • Other AD
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9
Q

T1DM Presentation

A 
Polydipsia 
Polyphagia 
Polyuria 
Glycosuria 
Weight loss
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10
Q

Complications of insulin therapy

A

Lipohypertrophy
Hypoglycaemia
Weight gain - Increase appetitte
Insulin resistance

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11
Q

Diabetes acute and subacute presentation

A 
young people 
2-6 weeks hx 
- Polydipsia 
-Polyuria 
-Weight loss 
Subacute 
same sx but less marked over months 
- Lack of energy 
-Visual problems 
-pruritus vulvae
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12
Q

DM Dx

A 
Greater than OR EQUAL TO
Fasting > 7mmol/L
Random > 11.1mmol/L 
Hba1c >48mmol/L
Diagnosis:
Sx - Hyperglycaemia 
- Symptomatic + 1 abnormal test
  • Asymptomatic + 2 abnormal tests
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13
Q

What is IGT and IFG

A

Impaired glucose tolerance - 2hrs post paranidal
Risk factor for future diabetes and CVD

Impaired fasting glucose - Abnormal fasting glucose result

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14
Q

Hyperglycaemic Sx

A 
Polyuria 
polydipsia 
Genital thrush 
Unexplained weight loss 
Lethargy 
Visual blurring
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15
Q

T1DM tx

A

Diet and excercise
insulin
- LAI - 2x a day
-SAI - Before a meal

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16
Q

T2DM epidemiology/RF

A 
Male 
Overweight in abdomen 
Older 
Asian - ethnicity 
Sedintary lifestyle
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17
Q

General tx for DM

A

Alter diet
Excercise
Weight control
Foot checks

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18
Q

DMT2 Tx

A 
1. Metformin (Biguanide)
If HbA1c>58mmol/L
2. Metformin + DPP4 inhibitor (Sitaglaptin)
3. Metformin + Pioglitazone 
4. Metflomin + DDP4i + SU

Aim HbA1c (48-53mmol/L)

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19
Q

Pharma and S/E - Biguanide

A

Decreases liver glucose production
Increases insulin sensitivity

S/E -

  • GI distrubances
  • Nausea
  • Diarrhoea
  • WEIGHT LOSS
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20
Q

Pharma and S/E SU

A 
Promote insulin secretion 
Eg: Gliclazide/ Glipizide 
S/E -
-Hypoglycaemia 
-WEIGHT GAIN (stimulate appetite)

CI:
-Pregnancy
can cross placenta - Hypo in baby

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21
Q

Pharma + S/E DPP4i and Pioglitazone

A

DPP4i- Increase incretin effect
No weigth gain or loss

Pioglitazone - ENhance glucose and F.A take up
S/E - WEIGHT GAIN

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22
Q

DM Macrovascular complications

A

IHD
Peripheral vascular disease
Stroke
Renovascular disease

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23
Q

Retinopathy

A 
- Pre proliferative:
Cotton wool spots 
heamorrhages 
-Proliferative:
new blood vessel formation 
- RF:
Long term DM 
HTN 
Poor glycaemic control 
Pregnancy
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24
Q

Neuropathy

RF + Sx

A

Decreased sensation in stocking distribution
Test - 10g monofilament
Increased insensitivity so increased risk of silent trauma
dryness–> cracjing –> ulceration –> ischaemia so failure to heal –> infection –> amputation

RF: Smoking
BMI
HTN

sx
Parasthesia
insesitivity
erectile dysfunction

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25
Nephropathy
Glomerular disease - glomerular BM thickening due to damage Microalbuminuria DX - urine dipstick A:C>3 RF: High BP Poor BG control tx- avoild oral hypoglycaemic agents excreted by kidneys
26
DKA RF
``` stopping insulin therapy surgery undiagnosed DM infection pancreatitis ```
27
DKA presentation
``` Sx dehydration - dry tounge -sunken eyes - reduced tissue turgor Abdo pain Vomitting ``` Signs Fruity breath Kussmauls resp
28
DKA dx
hyperglycaemia - BG>11mmol/L Ketonaemia Ketones >3mmol/L Acidosis pH<7.3 HC03<15mmol/L
29
DKA tx
Fluids and electrolytes Insulin * Risk of hypokalaemia
30
DKA patho
uncontolled catabolism w/ insulin def - Unrestrained hepatic gluconeogenesis - High glucose levels leads to osmotic duresis by kidneys --> dehydration - Peripheral lipolysis - Free F.A converted to ketones by liver
31
Hyperosmolar hyperglycaemic state - aetiology - hallamark
medical emergency charecterised by marked hyperglycaemia, hyperosmolality and mild to no ketosis -Insufficient oral hypoglycaemic agents - Precipiatated by infction (Pneumonia) - DMT2
32
HHS presentation
Insulin levels enough to inhibit Ketogenesis glucose production unrestrained Sx : Dehydration - secondary to osmotic diureses - dry tounge - dcresed tissue turgor - sunken eyes decreased lelvel of conciousness
33
HHS Dx
BG>11mmol/L | urine dipstick - Glycosuria
34
HHS tx
- Slow rate insulin infusion Increased insulin sensitivity - Heparin SC Hyperosmolar predisposes to MI/Stroke/Arterial thrombosis - restore electrolytes (K+)
35
Hypoglycaemia - levels - aetiology DM and non diabetics
plasma glucose <3mmol/L - Too much insulin/SU - Non diabetics Liver failure Addisons Islet cell tumour
36
Hypoglycaemia - presentation - tx
``` - Sx sweaty anxiety hunger dizziness ``` - Signs aggression sweaty seizures tx - Food IV glucose
37
Hormones that inhibit other hormones
SST inhibits GH Dopamine inhibits Prolactin
38
Hypertyroidism causes
``` Graves toxic multinodular goitre toxic adenoma drug induced: - Amioderone hyper - increased I2 content in drug hypo- prevents T4-->T3 conversion - Lithium -Iodine ```
39
Hyperthyroidism sx + signs
``` Sweating Increased thirst Weight loss Heat intolerance Diarrhoea Paliptations tremor anxiety ``` Signs : - tachy - lid retraction - lid lag - thin hair - onycholysis - Infrequent menses
40
Hyperthyroidism investigations
TFTs - Primary TSH = Low T3/T4= High - Secondary TSH = High T3/T4 = High - Thyroid auto-Ab TSH receptor ab Thyroid peroxidase thyroglobulin - Radioactive iodine isotope scan
41
Hyperthyroidism tx
Beta blockers - sx control Carbimazole radio-iodine therapy thyroidectomy
42
Graves disease - defintion - aetiology - pathology - specific signs
- AI hyperthyroidism - Stress, Infection, Childbirth - TSH receptor stimualting Ab bind to TSH receptor and stimulate T3 release --> enlargement --> follicular hyperplasia--> goitre - Exopthalmos - Pretibial myxoedema - Photophobia - diplopia - Increased tear production - Clubbing - finger and toe swelling
43
Toxic multinodular goitre - definiton - aetiology - epi - tx
nodules act indipendently and follicles secrete more T3 - Iodine deficeint areas - Elderly women - Surgery indicated for compressive sx dydphagia dyspnoea
44
Throid storm - sx and signs - precipitation - tx
``` Tachy + AF D+V Coma Delirum Fever ``` ``` - Precipitated by: infection stress radioactive iodine therpay surgery ``` ``` - tx: high dose carbimazole propanolol potassium iodide hydrocortisone - prevents conversion of T4 ```
45
Hyperthyroidism surgery risks + Carbimazole S/E
- damage recurrent laryngeal nerve --> hoarse voice - hypoparathyroidism ``` -S/E: Neutropenia sore throuat mouth ulcers rash ```
46
Hypothyroidism causes and associations
- I2 deficiency - AI hypothyroidism (Common) - Associated w/ DMT1 and Addisons - Hashimoto thyroiditis - Previous radioiodine therapy Hyperthyroidism tx - Drug induced - Amiodarone and Lithium - Post thyroidectomy - Radioiodine tx Increase incidence with age Female >Male
47
Hypothyroidism CP
Sx - Increase weight - Cold intolerance - Constipation - Tiredness - Low mood - Decreased memory - Lethargy - Menorrhagia ``` Signs B - Bradycardia R- Reflexes relax slowly A - Ataxia D - Dry skin/ Thin hair Y - Yawning C - Cold extremities A- Ascites R - Round puffy face D - Defeated demeanor I - Immobile C - Congestive HF ``` Heavy prolonged menses
48
Hyperthyroidism investigations
TFTs - - LOW Serum TSH - HIGH T3 + T4
49
Hypothyroidism tx
- Levothyroxine Normalise TSH levels (-ve feedback) * Massive drops in TSH --> AF and Osteoperosis Dose titrated until TSH levels normalised
50
Hypothyroidism complications and tx
Myxoedema coma: - Hypothermia - Hypoventilation - Hypoglycaemia - Cardiac failure tx: - IV T3 Glucose infusion gradual rewarming
51
Hashimotos thyroditis - Epidemiology - Pathology - Investigations - Tx
``` - Autoimmune hypothyroidism Females>Males - Middle aged (60-70y/o) -AI inflation of thyroid gland Goitre formation via lymphocytic + plasma cell infiltration Atrophy Hypothyroidism ``` - Thyroid peroxidase Ab present - Levothyroxine therapy shrinks goitre -
52
Thyroid carcinoma - RF - Patho - Presentation - DD
RF - Radiation Patho - Minimally active hormone Thyroglobulin - tumour marker after thyroid ablation ``` CP - SIgns: Thyroid nodules Cervical lymphadenopathy Increase gland size - hard/irregular (signals carcinoma) ``` Sx - - Dysphagia - Hoarseness of voice - Compression of laryngeal nerve + oesophagus DD - Goitre
53
TC - Diagnosis - Tx
- Dx 1. US 2. Blood test 3. Fine needle aspiration cytology biopsy - Tx Radioactive iodine - local irridation and destroys cancer Levothyroxine - Supress TSH which is a growth factor for the tumour Chemo - Reduce risk of spread + tx micrometastases
54
TC types (4) + tx
People Find Annette Loud - Papillary (70%) Young - good prognosis - Follicular (20%) Middle age Lung and bone mets good prognosis - Anaplastic (<5%) Aggresive local spread but poor prognosis Thyroid epithelium - Lymphoma (2%) - P+F = Thyroidectomy + ablative radioactive I2 - A = No response to radioactive iodine palliative - external radiograpjy
55
Which section of the adrenal cortex differs from the rest
Zona glomerulosa Not under hypothalamic- pituitary control Responds to renin release via juxtaglomeular cells of A.arteriole H/Pituitary pathology no effect on aldosterone secretion only kidney patho
56
Cortisol functions + when it is released
Circadian rhythm + stress functions: - Increase :Gluconeogenesis + Lipolysis+ Proteolysis - Increase peripheral B.V to adrenaline --> Vasoconstriction - Dampens immune response Decrease production of infamm mediators (IL+PG)
57
Cushings - Epidemiolgy - Causes
``` - 30-50y/o Aetiology: ACTH independent - Iatrogenic Oral steroids (long term) - COMMON - Adrenal adenoma ``` ``` ACTH dependent - Cushing's disease - COMMON - Ectopic ACTH production small cell lung cancer carcinoid syndrome ```
58
What is cushings disease
ACTH secreting adenoma leads to bilateral adrenal hyperplasia = increase cortisol
59
Cushing syndrome
excess cortisol and loss of hypothalamic pituitary axis feedback as well as circadian rhythm
60
Cushing sx
Sx - Weight gain - depression - lethargy - erectile dysfunction - acne signs - Abdo striae - buffalo hump - Moon face - Osteoperosis risk - Central obesity - bruises - HTN + High BG - Increase infection risk
61
Cushings - Investigations - DD
- Drug hx - Dexamethasone suppression test - failure to supress cortisol levels over 24hrs = Diagnostic - Urinary free cortisol 24hr - Alcohol pseudo-cushing syndrome
62
Cushings | Why no random plasma cortisol
May mislead as change with: - stress - time of day - illness
63
Cushings tx
Iatrogenic - stop meds cushings disease - surgical removal - pituirtary adenoma (Transphenoidal) Adrenal adeoma/carcinoma - Adrenelectomy + radiotherapy if malignant Ectopic - no spread = excision Metyrapone - inhibits cortisol synthesis
64
Why is cushings an endocrine cause of diabetes rans
- Increase insulin resistance - Decrease uptake by peripheral tissues - Increase hepatic glucose production
65
Acromegaly and giagntism
A = Excessive GH production in adults after epiphyseal growth plate fusion G = Excessive GH in children
66
GH - Secretion - Inhibition
Pulsatile fashion - controlled by GHRH - SST - inhibits GH - Inhibited by HIGH glucose
67
Acromegaly - Epi - Aetiology
- 40y/o - Pituitary adenoma - Ectopic GH secreting hormone from a carcinoid tumour
68
Acromegaly | Sx and signs
Sx - Arthralgia - Headache - Sweating - Decreased libido - Increase weight - Polyuria Signs - Growth of H and F - Macroglossia - Widely spaced feet - Darkening skin - Wide nose - Deep voice - Big supraorbital ridge - Coarsning face
69
Acromegaly Dx
- Increase IGF-1 levels (less fluctuations) - MRI pituitary fossa - OGTT Rise in BG will supress GH - Visual field exam
70
Acromegaly why not random plasma GH
Pulsatile hormone and levels vary throughout day - stress - sleep - puberty - pregnancy
71
Acromegaly tx
- Trans-sphenoidal surgery to remove tumour - SST analogues (OCTREOTIDE) - GH receptor antagonist (Decrease IGF-1 levels) - Dopamine
72
Acromegaly patho
-Increase GH -Binds to receptors and increases IGF-1 levels - Stimulates skeletal and ST growth - Local compression due to tumour expansion Headaches and visual fields loss
73
Acromegaly complications
Increasec risk of colon cancer Stroke DMT2 LV hypertrophy
74
Addison's disease definition and epidemiology
Primary adrenal insufficiency | F>M
75
Addison's aetiology + Assoc
``` AI adrenalitis - Autoantibodies againt adrenal cortex - 21-hydroxylase (common ag) - Associations: DMT1 Prenicious anaemia ```
76
Addisons patho
Attack of adrenal cortex by auto-Ab --> damage leading to decreased hormone secretion - Mineralocorticoid = Decreased Na+ and H20 retention --> Decreased BP --> Tachy - Decreased androgens --> Decreased libido - Decrease glucocoricoid --> Weight loss Fatigue Skin pigmentation (ACTH)
77
Addisons CP
Sx - weight loss - Tiredness - Vomitting Signs - Tanned - Tired - Tearful - Impotence/Amenorrhea - Depression - N&V - Abdo pain
78
Addison's Dx
- Short ACTH stimulation test Measure plasma cortisol Give syncathen If no rise in cortisol = Addisons - Test for 21-hydroxylase Ab + adrenal coretex auto-Ab - Hyponaktremia - Hyperkaleamia - Hypoglycaemia
79
Addisons tx
``` Hydrocortisone - 3x/day (Replace carcadian rhythm) - Pt education Warn aginst stopping Double dose - Infection/trauma Increase dose - pregnant or before excercise Steroid card and bracelet ```
80
Addisons complications
Adrenal crisis - Sudden decrease in glucocorticoid levels ``` -Sx Nausea Abdo pain Vomitting Muscle cramps ``` -Tx IV hydrocortisone
81
Conn's syndrome definition + secondary causes
Primary Hyperaldosteronisim - Excessive aldosterone production independent of RAAS - Most common cause of Secondary HTN
82
Conn's aetiology
1.Adrenal carcinoma (Conn's syndrome) 2. Bilateral adrenocorticol hyperplasia
83
Conn's RF
HTN in a pt<35 with no Family hx of HTN
84
Conn's CP
- Asx - Hypokalaemia - Cramps/weakness - Polyuria - Polydypsia
85
Conn's DD
Secondary hyperaldosteronism - Excess renin due to decreased renal perfusion Diuretics/CCF/R.Artery stenosis
86
Conn's Dx
- Renin:Aldosterone ratio High A:Low R = Primary High A:High R = Secondary - MRI --> Adrenal tumour - CT Angiogram --> R.A stenosis
87
Conn's tx
- Laproscopic adrenolectomy - Aldosterone antagonists Spirinolactone (4wks pre-op) - Stenosis --> Percutaneous R.A angioplasty
88
DI defenition + types
Lack of ADH hormone or lack of response to ADH Leads to polyuria (.3L/day) - dilute urine and Polydypsia - Nephrogenic - Cranial
89
DI causes
Cranial: Lack of hypothalamus ADH secretion - head trauma - tumour - Infection-meningitis - Idiopathic - Surgery Nephrogenic: Lack of response to ADH by CD - Lithium Inherited
90
DI CP
``` Polyuria Polydipsia Dehydration Hypernatraemia Weakness Postural hypotension ```
91
DI DD
DM Primary polydypsia Hypokalaemia
92
DI diagnosis
- Measure urine volume (>3L --> Confirm Polyuria) - Check BG --> Eclude DM ``` - Water deprevation test Fluid deprevation for 8hrs measure urine osmolality desmopressin given measure urine osmolality 8hrs later ``` Cranial - High urine osmolality Nephrogenis - Low and remain low urine osmolality Primary polydypsia - High urine osmolality after deprevation --> No DI
93
DI tx
- Tx underlying cause - Cranial Find cause - MRI of head and test for posterior pituitary tumour Tx --> Desmopressin Desmpressing has a long duration of action and no vasoconstrictive effects Nephrogenic - Tx cause: Renal disease High dose desmopressin under close monitoring
94
SIADH definition
Continued secretion of ADH despite low plasma osmolality
95
SIADH complication
Hyppnatraemia - H20 retention - Excess B.V Less conc Na+
96
SIADH causes
- Malignancy Prostate, Pancreas, SCC of lung -CNS Meningitis,Tumour, surgery, Head injury - Pulmonary lesions Pneumoniae, TB, CF - Metabolic Alcohol withdrawl
97
SIADH CP
``` Headaches Confusion Nausea Tremor Cerebral oedema Mood swings Hallucinations Vomitting Muscle cramps ``` Low Na+ Seizures and reduced conciousness
98
SIADH causes
Dx of exclusions: - Euvolemia - HIGH urine Na+ and osmolality - Hyponatraemia - Low plasma osmolality
99
Caues of hyponatraemia
``` burns vomitting hx of diuretic use excessive water intake AKI/CKD excessive sweating Adrenal insufficiency ```
100
SIADH Tx
Tx underlying cause If possible stop causative meds - Restrict fluids (500mls-1L) - ADH receptor antagonist TOLVAPTAN
101
Hyperkalaemia values and definition
High serum potassium >5.5mmol/L >6.5mmol/L --> Emergency
102
Hyperkalaemia aetiology
Conditions: - AKI - CKD - Rhabdomyolysis - Adrenal insufficeincy - Tumour lysis syndrome Meds - Aldosterone antagonist (Spironolactone) - ACEi - ARB - NSAIDs
103
Artefactual reasons for Hyper-K+
Haemolysis | delayed analysis
104
HYperkalaemia sx
weakness chest pain fast irregula rpulse light headedness
105
Hyperkalaemia Dx
ECG - Tall tented t waves - Absent P waves - Wide QRS complex
106
Hyperkalaemia Tx
Insulin + dextrose - drives K+ into cells Calcium gluconate -Cardio protective reducing the risk of arrhythmias
107
Hypokalaemia values and causes
<3.5mmol/L <2.5mmol/L --> Emergency ``` Causes: Diuretics tx - thiazides + loop Conn's Liver failure Heart failure Cushings V+D ```
108
Hypokalemia CP
``` Muscle weakness hypotonia cramps tetany constapation Palipitations ```
109
Hypokalaemia CP
Inverted t-waves U - waves Long PR-Interval Depressed ST segments
110
Hypokalaemia Tx -
Mild - Oral K+ supplements K+ sparing diuretic Severe - IV K+ (no more than 20mmol/h)
111
Hyperprolactinaemia aetiolgy
Prolatinoma Pituitary stalk damage drugs
112
Hyperprolactinaemia patho
``` Increased prolactin secretion Lactation - Galactorrhoea Inhibits GnRH Decreased LH/FSH/Androgens Oligo/Amenorrhea ```
113
Hyperprolactinaemia CP
``` oligo/amenorrhea Infertility dry vagina decreased libido erectile dysfunction ``` tumour: headache visual field defects
114
Hyperprolactinaemia Dx and Tx
Dx - Measure basal prolactin levels Tx - Dopamine agaonists CABERGOLINE
115
Carcinoid tumours defenition
Originate from enterochromaffin cells - capable of seratonin secretion
116
Carcinoid T CP
carcinoid syndrome only if liver mets - Flushing - Wheezing - Diarrhoea - Abdo pain - Increase HR - Nausea
117
Carcinoid syndrome tx
SST analogues | Surgical resection
118
Carcinoid syndrome?
Sx due to serotonin, kinins, histamine and PG enter circulation from secondary mets in the Liver
119
Actions of PTH
- Increases osteoclastic activity - Increased activity of 1-alpha-hydroxylase enzyme (Increasing Vit D activity) - Increase calcium reabsorption from kidney - Increase calcium absorption from gut
120
Primary hyperparathyroidism - causes - complications - tx
- Tumour of parathyroid glands - Hypercalcaemia - surgical removal
121
Secondary hyperparathyroidism - causes - tx
- Vit D deficiency - CKD Leads to hypocalcaemia Parathyroid glands increase PTH secretion Gland hyperplasia glands bulk up Normal serum calcium High PTH -Tx: Correct Vit D deficiency renal transplant
122
Tertiary hyperparathyroidism - causes - complications - tx
- Prolonged secondary hyperparathyroidism --> Hyperplasia of glands Increased baseline PTH level - Hypercalcaemia - Surgical removal part of gland tissue
123
Primary Hypoparathyroidism - causes - tests - signs - tx
Decreased PTH secretion due to gland failure - AI - Congenital (Digeorge) -Low Ca2+ High or normal PO4 - Signs of hypocalcaemia SPASMODIC - Calcium supplements + Calcitriol
124
Secondary hyperparathyroidism | - causes
Radaiation surgery - thyroidectomy Low Mg - required for PTH secretion
125
Pseudohypoparathyroidism - Definition - Signs - Tests
Failure of target cells to respond to PTH - Short 4th and 5th metacarpals - round face - short stature - calcified basal ganglia - Low Ca2+ High PTH High ALP
126
Pseudopseudohypoparathyroidism
morphological features of pesudohpoparathyroidim but with normal biochemistry - Genetic causes
127
Glucocorticoid S/E - Endocrine - MSK - Psychiatric - GI - Others
- Endocrine: Increased appetite/Weight gain Hyperlipidaemia Impaired glucose regulation - MSK Osteoperosis - Psychiatric Insomnia Depression - GI Peptic ulcer A. Pancreatitis -Other Neutophilia Supression of growth in kids Immunosuppression --> Increased susceptibility to infections
128
Mineralocorticoid S/E
Fludrocortisone - HTN - Sodium and water retention - Hypokalaemia
129
What do you do if a pateint on long term corticosteroids is ill
Double steroid dose

Phase 2a (11 decks)

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