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Phase 2a > Endocrine > Flashcards

Endocrine Flashcards

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
Q

Nephropathy

A

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

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26
Q

DKA RF

A 
stopping insulin therapy 
surgery 
undiagnosed DM
infection 
pancreatitis
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27
Q

DKA presentation

A 
Sx 
dehydration 
- dry tounge 
-sunken eyes 
- reduced tissue turgor 
Abdo pain 
Vomitting

Signs
Fruity breath
Kussmauls resp

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28
Q

DKA dx

A

hyperglycaemia
- BG>11mmol/L

Ketonaemia
Ketones >3mmol/L

Acidosis
pH<7.3
HC03<15mmol/L

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29
Q

DKA tx

A

Fluids and electrolytes
Insulin
* Risk of hypokalaemia

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30
Q

DKA patho

A

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
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31
Q

Hyperosmolar hyperglycaemic state

  • aetiology
  • hallamark
A

medical emergency charecterised by marked hyperglycaemia, hyperosmolality and mild to no ketosis
-Insufficient oral hypoglycaemic agents

  • Precipiatated by infction (Pneumonia)
  • DMT2
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32
Q

HHS presentation

A

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

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33
Q

HHS Dx

A

BG>11mmol/L

urine dipstick - Glycosuria

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34
Q

HHS tx

A
  • Slow rate insulin infusion
    Increased insulin sensitivity
  • Heparin SC
    Hyperosmolar predisposes to MI/Stroke/Arterial thrombosis
  • restore electrolytes (K+)
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35
Q

Hypoglycaemia
- levels
- aetiology
DM and non diabetics

A

plasma glucose <3mmol/L

  • Too much insulin/SU
  • Non diabetics
    Liver failure
    Addisons
    Islet cell tumour
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36
Q

Hypoglycaemia

  • presentation
  • tx
A 
- Sx 
sweaty
anxiety 
hunger
dizziness
  • Signs
    aggression
    sweaty
    seizures

tx -
Food
IV glucose

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37
Q

Hormones that inhibit other hormones

A

SST inhibits GH

Dopamine inhibits Prolactin

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38
Q

Hypertyroidism causes

A 
Graves 
toxic multinodular goitre 
toxic adenoma 
drug induced:
- Amioderone 
hyper - increased I2 content in drug 
hypo- prevents T4-->T3 conversion 
- Lithium 
-Iodine
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39
Q

Hyperthyroidism sx + signs

A 
Sweating 
Increased thirst 
Weight loss 
Heat intolerance 
Diarrhoea 
Paliptations 
tremor 
anxiety

Signs :

  • tachy
  • lid retraction
  • lid lag
  • thin hair
  • onycholysis
  • Infrequent menses
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40
Q

Hyperthyroidism investigations

A

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
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41
Q

Hyperthyroidism tx

A

Beta blockers - sx control

Carbimazole

radio-iodine therapy

thyroidectomy

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42
Q

Graves disease

  • defintion
  • aetiology
  • pathology
  • specific signs
A
  • 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
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43
Q

Toxic multinodular goitre

  • definiton
  • aetiology
  • epi
  • tx
A

nodules act indipendently and follicles secrete more T3

  • Iodine deficeint areas
  • Elderly women
  • Surgery indicated for compressive sx
    dydphagia
    dyspnoea
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44
Q

Throid storm

  • sx and signs
  • precipitation
  • tx
A 
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
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45
Q

Hyperthyroidism surgery risks + Carbimazole S/E

A
  • damage recurrent laryngeal nerve –> hoarse voice
  • hypoparathyroidism
-S/E:
Neutropenia
sore throuat 
mouth ulcers 
rash
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46
Q

Hypothyroidism causes and associations

A
  • 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

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47
Q

Hypothyroidism CP

A

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

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48
Q

Hyperthyroidism investigations

A

TFTs -

  • LOW Serum TSH
  • HIGH T3 + T4
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49
Q

Hypothyroidism tx

A
  • Levothyroxine
    Normalise TSH levels
    (-ve feedback)
  • Massive drops in TSH –> AF and Osteoperosis
    Dose titrated until TSH levels normalised
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50
Q

Hypothyroidism complications and tx

A

Myxoedema coma:

  • Hypothermia
  • Hypoventilation
  • Hypoglycaemia
  • Cardiac failure

tx:
- IV T3
Glucose infusion
gradual rewarming

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51
Q

Hashimotos thyroditis

  • Epidemiology
  • Pathology
  • Investigations
  • Tx
A 
- 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

-

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52
Q

Thyroid carcinoma

  • RF
  • Patho
  • Presentation
  • DD
A

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
Q

TC

  • Diagnosis
  • Tx
A
  • 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
Q

TC types (4) + tx

A

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
Q

Which section of the adrenal cortex differs from the rest

A

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
Q

Cortisol functions + when it is released

A

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
Q

Cushings

  • Epidemiolgy
  • Causes
A 
- 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
Q

What is cushings disease

A

ACTH secreting adenoma leads to bilateral adrenal hyperplasia = increase cortisol

59
Q

Cushing syndrome

A

excess cortisol and loss of hypothalamic pituitary axis feedback as well as circadian rhythm

60
Q

Cushing sx

A

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
Q

Cushings

  • Investigations
  • DD
A
  • Drug hx
  • Dexamethasone suppression test - failure to supress cortisol levels over 24hrs = Diagnostic
  • Urinary free cortisol 24hr
  • Alcohol pseudo-cushing syndrome
62
Q

Cushings

Why no random plasma cortisol

A

May mislead as change with:

  • stress
  • time of day
  • illness
63
Q

Cushings tx

A

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
Q

Why is cushings an endocrine cause of diabetes rans

A
  • Increase insulin resistance
  • Decrease uptake by peripheral tissues
  • Increase hepatic glucose production
65
Q

Acromegaly and giagntism

A

A = Excessive GH production in adults after epiphyseal growth plate fusion

G = Excessive GH in children

66
Q

GH

  • Secretion
  • Inhibition
A

Pulsatile fashion

  • controlled by GHRH
  • SST - inhibits GH
  • Inhibited by HIGH glucose
67
Q

Acromegaly

  • Epi
  • Aetiology
A
  • 40y/o
  • Pituitary adenoma
  • Ectopic GH secreting hormone from a carcinoid tumour
68
Q

Acromegaly

Sx and signs

A

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
Q

Acromegaly Dx

A
  • Increase IGF-1 levels (less fluctuations)
  • MRI pituitary fossa
  • OGTT
    Rise in BG will supress GH
  • Visual field exam
70
Q

Acromegaly why not random plasma GH

A

Pulsatile hormone and levels vary throughout day

  • stress
  • sleep
  • puberty
  • pregnancy
71
Q

Acromegaly tx

A
  • Trans-sphenoidal surgery to remove tumour
  • SST analogues (OCTREOTIDE)
  • GH receptor antagonist (Decrease IGF-1 levels)
  • Dopamine
72
Q

Acromegaly patho

A

-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
Q

Acromegaly complications

A

Increasec risk of colon cancer
Stroke
DMT2
LV hypertrophy

74
Q

Addison’s disease definition and epidemiology

A

Primary adrenal insufficiency

F>M

75
Q

Addison’s aetiology + Assoc

A 
AI adrenalitis 
- Autoantibodies againt adrenal cortex 
- 21-hydroxylase (common ag)
- Associations:
DMT1
Prenicious anaemia
76
Q

Addisons patho

A

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
Q

Addisons CP

A

Sx

  • weight loss
  • Tiredness
  • Vomitting

Signs

  • Tanned
  • Tired
  • Tearful
  • Impotence/Amenorrhea
  • Depression
  • N&V
  • Abdo pain
78
Q

Addison’s Dx

A
  • 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
Q

Addisons tx

A 
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
Q

Addisons complications

A

Adrenal crisis
- Sudden decrease in glucocorticoid levels

-Sx
Nausea 
Abdo pain 
Vomitting 
Muscle cramps

-Tx
IV hydrocortisone

81
Q

Conn’s syndrome definition + secondary causes

A

Primary Hyperaldosteronisim
- Excessive aldosterone production independent of RAAS

  • Most common cause of Secondary HTN
82
Q

Conn’s aetiology

A

1.Adrenal carcinoma
(Conn’s syndrome)

  1. Bilateral adrenocorticol hyperplasia
83
Q

Conn’s RF

A

HTN in a pt<35 with no Family hx of HTN

84
Q

Conn’s CP

A
  • Asx
  • Hypokalaemia - Cramps/weakness
  • Polyuria
  • Polydypsia
85
Q

Conn’s DD

A

Secondary hyperaldosteronism
- Excess renin due to decreased renal perfusion
Diuretics/CCF/R.Artery stenosis

86
Q

Conn’s Dx

A
  • Renin:Aldosterone ratio
    High A:Low R = Primary
    High A:High R = Secondary
  • MRI –> Adrenal tumour
  • CT Angiogram –> R.A stenosis
87
Q

Conn’s tx

A
  • Laproscopic adrenolectomy
  • Aldosterone antagonists
    Spirinolactone (4wks pre-op)
  • Stenosis –> Percutaneous R.A angioplasty
88
Q

DI defenition + types

A

Lack of ADH hormone or lack of response to ADH
Leads to polyuria (.3L/day) - dilute urine and Polydypsia

  • Nephrogenic
  • Cranial
89
Q

DI causes

A

Cranial: Lack of hypothalamus ADH secretion

  • head trauma
  • tumour
  • Infection-meningitis
  • Idiopathic
  • Surgery

Nephrogenic: Lack of response to ADH by CD
- Lithium
Inherited

90
Q

DI CP

A 
Polyuria
Polydipsia 
Dehydration 
Hypernatraemia 
Weakness 
Postural hypotension
91
Q

DI DD

A

DM
Primary polydypsia
Hypokalaemia

92
Q

DI diagnosis

A
  • 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
Q

DI tx

A
  • 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
Q

SIADH definition

A

Continued secretion of ADH despite low plasma osmolality

95
Q

SIADH complication

A

Hyppnatraemia
- H20 retention
- Excess B.V
Less conc Na+

96
Q

SIADH causes

A
  • Malignancy
    Prostate, Pancreas, SCC of lung

-CNS
Meningitis,Tumour, surgery, Head injury

  • Pulmonary lesions
    Pneumoniae, TB, CF
  • Metabolic
    Alcohol withdrawl
97
Q

SIADH CP

A 
Headaches 
Confusion 
Nausea
Tremor 
Cerebral oedema 
Mood swings
Hallucinations 
Vomitting 
Muscle cramps

Low Na+
Seizures and reduced conciousness

98
Q

SIADH causes

A

Dx of exclusions:

  • Euvolemia
  • HIGH urine Na+ and osmolality
  • Hyponatraemia
  • Low plasma osmolality
99
Q

Caues of hyponatraemia

A 
burns 
vomitting 
hx of diuretic use 
excessive water intake 
AKI/CKD
excessive sweating 
Adrenal insufficiency
100
Q

SIADH Tx

A

Tx underlying cause
If possible stop causative meds

  • Restrict fluids (500mls-1L)
  • ADH receptor antagonist
    TOLVAPTAN
101
Q

Hyperkalaemia values and definition

A

High serum potassium
>5.5mmol/L
>6.5mmol/L –> Emergency

102
Q

Hyperkalaemia aetiology

A

Conditions:

  • AKI
  • CKD
  • Rhabdomyolysis
  • Adrenal insufficeincy
  • Tumour lysis syndrome

Meds

  • Aldosterone antagonist (Spironolactone)
  • ACEi
  • ARB
  • NSAIDs
103
Q

Artefactual reasons for Hyper-K+

A

Haemolysis

delayed analysis

104
Q

HYperkalaemia sx

A

weakness
chest pain
fast irregula rpulse
light headedness

105
Q

Hyperkalaemia Dx

A

ECG

  • Tall tented t waves
  • Absent P waves
  • Wide QRS complex
106
Q

Hyperkalaemia Tx

A

Insulin + dextrose
- drives K+ into cells

Calcium gluconate
-Cardio protective reducing the risk of arrhythmias

107
Q

Hypokalaemia values and causes

A

<3.5mmol/L
<2.5mmol/L –> Emergency

Causes:
Diuretics tx - thiazides + loop
Conn's 
Liver failure 
Heart failure 
Cushings 
V+D
108
Q

Hypokalemia CP

A 
Muscle weakness 
hypotonia 
cramps 
tetany 
constapation 
Palipitations
109
Q

Hypokalaemia CP

A

Inverted t-waves
U - waves
Long PR-Interval
Depressed ST segments

110
Q

Hypokalaemia Tx -

A

Mild -
Oral K+ supplements
K+ sparing diuretic

Severe -
IV K+ (no more than 20mmol/h)

111
Q

Hyperprolactinaemia aetiolgy

A

Prolatinoma
Pituitary stalk damage
drugs

112
Q

Hyperprolactinaemia patho

A 
Increased prolactin secretion 
Lactation - Galactorrhoea
Inhibits GnRH 
Decreased LH/FSH/Androgens 
Oligo/Amenorrhea
113
Q

Hyperprolactinaemia CP

A 
oligo/amenorrhea 
Infertility 
dry vagina 
decreased libido 
erectile dysfunction

tumour:
headache
visual field defects

114
Q

Hyperprolactinaemia Dx and Tx

A

Dx - Measure basal prolactin levels

Tx - Dopamine agaonists
CABERGOLINE

115
Q

Carcinoid tumours defenition

A

Originate from enterochromaffin cells - capable of seratonin secretion

116
Q

Carcinoid T CP

A

carcinoid syndrome only if liver mets

  • Flushing
  • Wheezing
  • Diarrhoea
  • Abdo pain
  • Increase HR
  • Nausea
117
Q

Carcinoid syndrome tx

A

SST analogues

Surgical resection

118
Q

Carcinoid syndrome?

A

Sx due to serotonin, kinins, histamine and PG enter circulation from secondary mets in the Liver

119
Q

Actions of PTH

A
  • 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
Q

Primary hyperparathyroidism

  • causes
  • complications
  • tx
A
  • Tumour of parathyroid glands
  • Hypercalcaemia
  • surgical removal
121
Q

Secondary hyperparathyroidism

  • causes
  • tx
A
  • 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
Q

Tertiary hyperparathyroidism

  • causes
  • complications
  • tx
A
  • Prolonged secondary hyperparathyroidism –> Hyperplasia of glands
    Increased baseline PTH level
  • Hypercalcaemia
  • Surgical removal part of gland tissue
123
Q

Primary Hypoparathyroidism

  • causes
  • tests
  • signs
  • tx
A

Decreased PTH secretion due to gland failure

  • AI
  • Congenital (Digeorge)

-Low Ca2+
High or normal PO4

  • Signs of hypocalcaemia
    SPASMODIC
  • Calcium supplements + Calcitriol
124
Q

Secondary hyperparathyroidism

- causes

A

Radaiation
surgery - thyroidectomy
Low Mg - required for PTH secretion

125
Q

Pseudohypoparathyroidism

  • Definition
  • Signs
  • Tests
A

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
Q

Pseudopseudohypoparathyroidism

A

morphological features of pesudohpoparathyroidim but with normal biochemistry

  • Genetic causes
127
Q

Glucocorticoid S/E

  • Endocrine
  • MSK
  • Psychiatric
  • GI
  • Others
A
  • 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
Q

Mineralocorticoid S/E

A

Fludrocortisone

  • HTN
  • Sodium and water retention
  • Hypokalaemia
129
Q

What do you do if a pateint on long term corticosteroids is ill

A

Double steroid dose

Phase 2a (11 decks)

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