Endocrine

Question 1

what is the difference between primary and secondary disease

Answer 1

primary - problem with the actual gland, graves disease

secondary - a problem in another gland is having an effect on the secretions of another gland

Question 2

what stimulates release of hormones from pituitary gland

Answer 2

hormones or nerve activation from hypothalamis

Question 3

what hormones are released from pituitary gland

Answer 3

anterior - acth, growth hormone, fsh, lh, tsh

posterior - adh, prolactin

Question 4

what are the types of tumour in the pituitary gland

Answer 4

functional - can still release hormones but levels may be skewered,
non-functional - no release of hormones

Question 5

what is the change of hormones released in functional tumours at different ages

Answer 5

younger than 40 - increase in ACTH, stimulates release of cortisol, result in cushings disease
older than 40 - growth hormone, results in acromegaly

Question 6

what is acromegaly

Answer 6

increase in GH but bones have fused so growing bones cannot grow any longer. instead, get increase of bulk in bones in mandible, skull, nose, fingers, feet, and increase in thickness of soft tissue

Question 7

how can acromegaly be tested for

Answer 7

GH test isnt stable, instead measure insulin like growth factor - might have increased spacing or loose fitting denture

Question 8

what can cause hyperthroidism

Answer 8

graves disease - antibody fitting into TSH receptor, stimulating production of thyroid hormone
tumour - more likely to be primary than secondary

Question 9

what are the symptoms of hyperthyroidism

Answer 9

symptoms - sweating, fast heart rate, anxious, ophthalamopy

signs - tachycardia, warm skin, atrial fibrillation, higher BP, goitre

Question 10

how can hyperthyroidism be treated

Answer 10

carbimazole, blocks action of T4, beta blockers to reduce effect, surgery to reduce size

Question 11

what can cause hypothyroidism

Answer 11

hashimoto’s disease - antigens stimulating production of antibodies against thyroid gland
secondary - non-functioning adenoma in pituitary

Question 12

what are the symptoms of hypothyroidism

Answer 12

symptoms - weight gain, constipation, tiredness

signs - bradycardia, hyperlipidaemia, dry coarse skin

Question 13

how can hypothyroidism be treated

Answer 13

by giving thyroxin

Question 14

how would blood test help to define the cause of hyperthyroidism

Answer 14

all causes will have high T3
low TSH - primary cause - graves disease
high TSH - secondary cause - pituitary

Question 15

how would blood test help to define cause of hypothyroidism

Answer 15

all causes will have low T3
low TSH - secondary cause - pituitary tumour
high TSH - primary cause - hashimotos disease

Question 16

what is the difference between diabetes mellitus and insipidus

Answer 16

mellitus - to do with glucose levels in the blood, hyperglycaemia
insipidus - lack of ADH so unable to concentrate urine

Question 17

how can diabetes mellitus be diagnosed

Answer 17

random glucose test - not always accurate, glucose levels may be high if just ate carbohydrates
fasting test - levels of glucose normally
glucose tolerance test - measure levels before eating then 2 hours after, if above 11.1 - diabetes

Question 18

what causes type 1 diabetes

Answer 18

autoimmune disease against insulin, unable to get glucose into cells, antibodies may be - islet cell autoantibody, insulin auto antibodies, glutamic acid decarboxylase

Question 19

what symptoms are present in type 1

Answer 19

diabetes symptoms - polyuria, polydipsia and tiredness

also hyperglycaemia and ketoacidosis

Question 20

what is ketoacidosis

Answer 20

diabetics are unable to get glucose into cells so instead use ketones for energy production. acid is produced as a by product, this increases acid in body - can be dangerous or fatal

Question 21

how is type 2 diabetes diagnosed

Answer 21

normally from non-type 1

Question 22

why are type 2 diabetics less likely to go into ketoacidosis

Answer 22

they have a low level of insulin to prevent it, normally present before it gets to this stage, however, if left long enough they will

Question 23

what causes type 2 diabetes

Answer 23

poor diet and lack of exercise, constantly releasing insulin, cells become desensitised, also eventually run out of insulin

Question 24

what complications are normally associated with type 2 diabetes

Answer 24

hyperlipidaemia, cardiovascular problems, more unusual infections

Question 25

what are symptoms of type 2 diabetes

Answer 25

obesity, hypertension, infections, hyperglycaemia

Question 26

compare type 1 and type 2

Answer 26

type 1 - hyperglycaemia with ketoacidosis, presents with diabetic symptoms (polyuria, polydipsia, tiredness), young and thin type 2 - old and fat, more complications (infections and cardiovascular problems), less likely to go into ketoacidosis

Question 27

how is type 1 diabetes managed

Answer 27

insulin injections. can be done by themselves or nurse. doing it themselves - more control over it, can eat when they like, if a nurse - only get it twice a day so need to plan around insulin injections

Question 28

how is type 2 diabetes managed

Answer 28

changing lifestyle, diet and exercise, may be on drugs to improve insulin release and increase sensitivity to insulin (sulphonylureas and biguanides)

Question 29

what is hypoglycaemia

Answer 29

low blood sugar levels, when take insulin and dont eat, levels get too low, can cause dizzyness, increase in hR and confusion before unconsciousness

Question 30

what are some complications of diabetes

Answer 30

hypo, large vessel disease - increased risk of atherosclerosis, angina and hypertension small vessel disease - poor wound healing, increased infection risk, neuropathy

Question 31

what might cause adrenal hyperfunction

Answer 31

primary tumour - adrenal adenoma | secondary - pituitary tumour, functioning

Question 32

what would be the consequence and symptoms of adrenal hyperfunction

Answer 32

excess cortisol and aldosterone. cushing's syndrome symptoms - diabetes type 2 symptoms, weight gain, infections, back pain signs - hypertension, obesity, thin skin

Question 33

how would the cause of adrenal hyperfunction be investigated

Answer 33

check blood levels of ACTH and cortisol cortisol will always be high if ACTH high - pituitary tumour, negative feedback not working. if ACTH low - primary tumour

Question 34

what might cause adrenal hypofunction

Answer 34

may be autoimmune attacking adrenal gland | or secondary - non-functioning pituitary tumour

Question 35

what are some symptoms of adrenal hypofunction

Answer 35

weight loss and lethargy signs - hypotension, due to lack of aldosterone for fluid reabsorption addisons disease

Question 36

how can addisons disease be investigated

Answer 36

blood test for cortisol and acth cortisol is always low if acth low - secondary, pituitary adenoma if acth high - primary, autoimmune can also use synthacth - if positive result - primary cause

Question 37

what is addisons crisis

Answer 37

hypovolemia, vomiting and fluid loss - need fluid in and iv steroid - lack of aldosterone and cortisol

Question 38

how is addisons disease treated

Answer 38

by giving fludrocortisone - replacement for aldosterone and hydrocortisone for cortisol, also fluid replacement

Question 39

what is the difference between patients with addisons disease and those on synthetic steroids

Answer 39

addisons disease only need replacement of physiological control, unable to reabsorb fluid so hypovolemia and hypotension, whereas steroids give supra-physiological control, more than they require, normally have hypertension

Question 40

what is the problem with patients on synthetic steroids for a long period of time

Answer 40

high levels of cortisol so switch of production of cortisol, can get adrenal atrophy. when they then come off medication, get an increase in ACTH but nothing to stimulate and unable to produce their own cortisol

Question 41

why can the dose of steroid given not fixed

Answer 41

because levels of cortisol released is dependant on environment and stimulus, if get an infection, get an increase in cortisol released, in response to stress

Question 42

what patients might require steroid prophylaxis

Answer 42

those with addisons disease, only getting enough for physiological normal. those on synthetic steroids already have more than they need so they should be fine for an infection

Question 43

what advice should be given to patients on prednisolone after dental treatment

Answer 43

if over 15mg - dont have to do anything, should have enough if 1-15mg - should double their dose on the day of treatment and for 2 days after, increases just incase of stress they have enough cortisol to prevent adisonian crisis those who have stopped taking steroids in the past 3 months - should be given just incase

Question 44

what dental treatment requires steroid prophylaxis

Answer 44

minor oral surgery or spreading dental infection | routine or restoration - not required

Question 45

what is also common in patients on steroids - dental aspects

Answer 45

candida infections, increased risk of diabetes - type 2, other complications also involved - e.g. cardiovascular disease, oral pigmentation