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phase2a medicine > endocrine diseases > Flashcards

endocrine diseases Flashcards

Risk factors, pathology, signs, complications, diagnosis, and treatment for all endocrine conditions on the phase 2a list. (142 cards)

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1
Q

diabetes mellitus

A

metabolic disorder of chronic hyperglycaemia due to insulin resistance or deficiency

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2
Q

T1DM risk factors

A

hypothyroidism
Addison’s
Coeliac disease

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3
Q

T2DM risk factors

A

HLA DR3 mutation
family history
lifestyle

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4
Q

secondary diabetes due to

A

haemochromatosis, cancer, CF

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5
Q

signs of diabetes

A 
polyuria
polydipsia
tiredness
blurred vision
weight loss (due to water loss and gluconeogenesis)
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6
Q

signs of diabetic ketoacidosis

A

chronic hyperglycaemia
raised plasma ketones
metabolic acidosis (low bicarbonate)
kussmaal breathing

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7
Q

How does diabetic ketoacidosis occur?

A

reduced insulin –> reduced fat breakdown and formation of glycerol and free fatty acids –> impair glucose uptake and are transported to liver –> oxidised to ketone bodies

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8
Q

complications of diabetes mellitus

A 
microvascular disease:
stroke and CVD
retinopathy due to leakage and occlusion of blood vessels (protein, fat, and glial cells grow down blood vessels)
neuropathy
nephropathy 
peripheral vascular disease
foot ulceration
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9
Q

fasting glucose diabetes mellitus diagnosis

A

> 7 mmol/L

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10
Q

random glucose diabetes mellitus diagnosis

A

> 11.1 mmol/L

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11
Q

HbA1c diabetes mellitus diagnosis

A

> 6.5%

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12
Q

test urine to diagnose diabetes

A

moderate to large urinary ketones

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13
Q

T1DM treatment

A

insulin

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14
Q

T2DM treatment

A

lifestyle modifications
statins and bp lowering drugs
metformin
sulfonylureas (e.g. gliclazide)

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15
Q

how does metformin work?

A

it reduces gluconeogenesis and increases glucose sensitivity

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16
Q

treatment of DKA

A

rehydration
insulin
electrolyte replacement
treat underlying cause

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17
Q

risk factors for hyperthyroidism

A 
hyperiodinism
too much synthetic thyroxine
Graves' disease
thyroiditis
amiodarone
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18
Q

primary hyperthyroidism

A

high T3 and T4

low TSH

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19
Q

secondary hyperthyroidism

A

high T3 and T4

high TSH

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20
Q

signs of hyperthyroidism

A

prefers cold weather, bad tempered

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21
Q

symptoms of hyperthyroidism

A 
pretibial myxoedema (rare)
sweaty
diarrhoea
oligomenorrhoea
weight loss
tremor
palpitations
visual problems
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22
Q

complications of hyperthyroidism

A

osteoporosis

thyroid storm

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23
Q

treatment of hyperthyroidism

A 
radioiodine therapy
thyroid surgery 
beta-blockers
carbimazole
thionamide
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24
Q

risk factors for hypothyroidism

A

low dietary iodine
Hashimoto’s thyroiditis (autoimmune)
surgery
post-partum thyroiditis (affects 1 in 20 women)
other autoimmune conditions: T1DM, Addison’s, vitiligo, alopecia

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25
primary hypothyroidism
high TSH | low T3 and T4
26
secondary hypothyroidism
pituitary dysfunction | low T3, T4, and TSH
27
tertiary hypothyroidism
hypothalamus problem | low T3, T4, and TSH
28
signs of hypothyroidism
prefers warm weather | goitre
29
symptoms of hypothyroidism
``` depressed slow tired thin hair croaky voice heavy periods constipation dry skin puffy face ```
30
diagnosis of hyperthyroidism
thyroid function test - raised T4, low TSH
31
diagnosis of hypothyroidism
thyroid function test - low T4, TSH varies throughout the day (higher when dark) check for thyroid autoantibodies
32
treatment of primary hypothyroidism
levothyroxine
33
thyroxine dose for patient with hypothyroidism
1.6mg per kg of body weight
34
autoimmune hypothyroidism
inflammatory infiltrate replaces follicles thyroglobulin and thyroid peroxidase antibodies thyroid cell destruction is mediated by CD8 T cells
35
risk factors for Grave's disease
``` genetic environmental female smoking having another autoimmune disorder ```
36
pathology of Grave's disease
thyroid stimulating immunoglobulin causes excess production of thyroid hormones
37
signs of Grave's disease
``` poor heat tolerance sleeping problems tachycardia acropachy (finger clubbing) proptosis (eye bulging) ```
38
symptoms of Grave's disease
``` pretibial myxoedema eye bulging unintentional weight loss muscle weakness goitre oligomenorrhoea hand tremor ```
39
complications of Grave's disease
Grave's ophthalmopathy
40
treatment of Grave's disease
radioiodine uptake therapy thyroid surgery beta blockers carbimazole
41
action of carbimazole
acts on thyroid peroxidase enzyme
42
risk factors for Hashimoto's thyroiditis
female over 60 HLA-DR5
43
Hashimoto's thyroiditis
gradual autoimmune destruction of the thyroid gland goitre due to lymphocyte and plasma cell infiltration
44
signs of Hashimoto's thyroiditis
panic disorder heavy periods enlarged and lobulated thyroid
45
symptoms of Hashimoto's thyroiditis
``` goitre weight gain feeling tired constipation depression ```
46
complications of Hashimoto's thyroiditis
thyroid lymphoma (non-Hodgkin)
47
diagnosis of Hashimoto's thyroiditis
antithyroid peroxidase antibodies (TPOAb) | anti-thyroglobulin antibodies
48
treatment of Hashimoto's thyroiditis
levothyroxine
49
cause of Cushing's disease
pituitary adenoma | or ectopic tumour producing ACTH
50
pathology of Cushing's disease
adrenal gland produces more cortisol due to excess ACTH
51
signs of Cushing's disease
``` hypertension weak muscles acne fragile skin which heals poorly central obesity osteoporosis ```
52
symptoms of Cushing's disease
``` central obesity with thin arms and legs hump women have more hair irregular menstruation chronic tiredness proximal myopathy ```
53
symptoms of Cushing's disease
``` central obesity with thin arms and legs hump women have more hair irregular menstruation chronic tiredness proximal myopathy purple abdominal striae ```
54
diagnosis of Cushing's disease and Cushing's syndrome
Dexamethasone suppression test 1. check medication 2. check levels of cortisol after taking dexamethasone 3. if cortisol remains high, do a blood test for ACTH - ACTH will be high if patient has Cushing's
55
treatment of Cushing's disease and Cushing's syndrome
treat underlying cause
56
risk factors for prolactinoma
female
57
prolactinoma pathology
lactotroph cell pituitary tumour | or may be tumour in pituitary fossa that interrupts stalk and stops dopamine
58
signs of prolactinoma
``` visual field defect CSF leak infertility galactorrhoea amenorrhoea low testosterone ```
59
symptoms of prolactinoma
headache changes in menstrual cycle low libido
60
diagnosis of prolactinoma
blood test - check prolactin levels medical imaging drug history
61
treatment of prolactinoma
dopamine agonists - cause tumour to shrink microadenoma responds to small doses of cabergoline
62
mean age at diagnosis for acromegaly
44
63
pathology of acromegaly
pituitary tumour releasing growth hormone --> IGF-1 released from liver --> growth of hands and tongue
64
signs of acromegaly
``` arthralgias (joint pain) acral enlargement (hands) maxillofacial changes excessive sweating hypogonadal symptoms macroglossa prognathism frontal bossing ```
65
symptoms of acromegaly
``` increased size of extremities snoring deep voice decreased libido headache arthralgia ```
66
complications of acromegaly
``` osteoarthritis T2DM sleep apnoea hypertension CAD stroke headache life expectancy decreased by 10 years ```
67
diagnosis of acromegaly
glucose tolerance test can exclude by finding low serum GH MRI scan IGF-1
68
treatment of acromegaly
surgery somatostatin analogues (octreotide) pegvisomant growth hormone analogue radiotherapy (takes about 5 years - eventually turns tumour to scar tissue)
69
pathology of Conn's syndrome
primary hyperaldosteronism resulting in low renin often due to adrenal gland enlargement or an adrenal gland adenoma
70
signs of Conn's syndrome
``` hypertension muscular weakness excessive micturition poor vision signs of hypokalaemia (e.g. muscle problems) ```
71
symptoms of Conn's syndrome
headaches muscle spasms tingling sensations
72
complications of Conn's syndrome
cardiovascular disease
73
diagnosis of Conn's syndrome
U&E - low renin, high aldosterone adrenal vein sampling medical imaging
74
treatment of Conn's syndrome
surgery aldosterone antagonists (spironolactone) low salt diet dexamethasone (for familial disease)
75
risk factors for Addison's disease
``` primary adrenal insufficiency past history of TB post-partum bleed cancer steroids ```
76
pathology of Addison's disease
autoimmune adrenal destruction | decrease in adrenal function causes increase in ACTH
77
signs of Addison's disease
skin colour changes decrease in aldosterone --> decrease in Na+ and increase in K+ alopecia
78
symptoms of Addison's disease
``` lean tired anorexia weakness fever confusion depression ```
79
complications of Addison's disease
adrenal crisis and death under physiological stress
80
diagnosis of Addison's disease
imaging | ACTH stimulation test - cortisol remains low
81
primary Addison's disease diagnosis
high ACTH | high renin
82
secondary Addison's disease diagnosis
low ACTH
83
treatment of Addison's disease
hydrocortisone for cortisol | fludrocortisone for mineralocorticoids
84
why does Addison's disease cause pigmented skin?
ACTH acts on melanocortin receptor on adrenal glands and on skin
85
risk factors for hyperkalaemia
``` low aldosterone WNK1 and WNK4 mutations low sodium delivery to DCT low serum potassium level kidney injury Addison's disease drugs - ACEi, spironolactone ```
86
pathology of hyperkalaemia
excessive intake, decreased secretion, or a shift of potassium from the intracellular to the extracellular space
87
signs of hyperkalaemia on ECG
tall tented T waves small P waves wide QRS complex ventricular fibrillation
88
symptoms of hyperkalaemia
``` frank muscle paralysis dyspnoea palpitations chest pain nausea vomiting paresthesias ```
89
complications of hyperkalaemia
cardiac arrest
90
diagnosis of hyperkalaemia
ECG urine potassium, sodium, and osmolality FBC metabolic profile
91
treatment of hyperkalaemia
polystyrene-sulfonate resin furosemide haemodialysis insulin with glucose
92
hypokalaemia risk factors
poverty | poor diet
93
causes of hypokalaemia
``` diuretics vomiting and diarrhoea pyloric stenosis rectal villous adenoma intestinal fistula Cushing's syndrome steroids ACTH Conn's syndrome alkalosis renal tubular failure ```
94
signs of hypokalaemia
``` muscle weakness hypotonia hyporeflexia cramps tetany palpitations light-headedness constipation ```
95
complications of hypokalaemia
cardiac arrest following bradycardia
96
diagnosis of hypokalaemia
bloods - U&Es | ECG
97
treatment of hypokalaemia
tentative supplementation of potassium
98
risk factors for syndrome of inappropriate secretion of ADH (SIADH)
``` cancer CNS disorders chest disease hypothyroidism drugs ```
99
which cancers can cause SIADH?
lung small cell pancreatic cancer thymus cancer lymphoma
100
which CNS disorders can cause SIADH?
``` meningoencephalitis abscess stroke subarachnoid haemorrhage subdural haemorrhage trauma neurosurgery Guillain-Barré vasculitis SLE ```
101
which chest diseases can cause SIADH?
TB pneumonia abscess aspergillosis
102
which drugs can cause SIADH?
opiates psychotropics SSRIs cytotoxics
103
signs of SIADH
anorexia | lethargy
104
symptoms of SIADH
chronic pain
105
diagnosis of SIADH
U&Es | diagnosis of exclusion
106
treatment of SIADH
treat the cause restrict fluid (only 1L/day) - measure input and output salt ± loop diuretic (furosemide) demeclocycline if fluid restriction not working vasopressin receptor antagonists (tolvaptan)
107
risk factors for diabetes insipidus
disease of kidney or pituitary
108
pathology of diabetes insipidus
the passage of large volumes of dilute urine (more than 3L/day) due to impaired water resorption by the kidney
109
cranial diabetes insipidus
reduced ADH secretion from the posterior pituitary
110
nephrogrenic diabetes insipidus
impaired response of the kidney to ADH
111
symptoms of diabetes insipidus
``` polyuria polydipsia dehydration symptoms of hypernatraemia no glucosuria ```
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diagnosis of diabetes insipidus
water deprivation test - osmolarity won't rise | more than 3L urine a day
113
differentiating cranial from nephrogenic diabetes insipidus
osmolarity will increase following desmopressin in cranial, but not in nephrogenic
114
treatment of cranial diabetes insipidus
desmopressin
115
treatment of nephrogenic diabetes insipidus
treat the cause try bendroflumethiazide if it persists NSAIDs
116
why do NSAIDs lower urine volume and plasma Na+?
they inhibit prostaglandin synthase (prostaglandins locally inhibit the action of ADH)
117
pathology of hypercalcaemia of malignancy
PTH-RP released from cancer cells, or breakdown of bone
118
symptoms fo hypercalcaemia of malignancy
``` bone pain abdominal pain kidney stones nausea constipation polyuria lethargy depression ``` bones, stones, groans, and moans
119
complications of hyperacalcaemia of malignancy
QT gets shorter
120
treatment of hypercalcaemia of malignancy
bisphosphonates calcitonin fluids
121
what can cause a false reading of hypercalcaemia?
tourniquet on for too long | sample old and haemolysed
122
hypocalcaemia risk factors
low serum albumin low magnesium vitamin D deficiency
123
signs of hypocalcaemia
``` SPASMODIC Spasms (Chvostek's sign on face and Trousseau's sign on hand) Paraesthesia Anxiety Seizures Muscle tone increase Orientation difficulties Dermatitis Impetigo herpetiformis Cataracts ```
124
complications of hypocalcaemia
QT gets longer
125
treatment of hypocalcaemia
calcium gluconate | cardiac monitoring
126
pathology of primary hyperparathyroidism
autonomous PTH secretion | parathyroid gland adenoma
127
complications of hyperparathyroidism
pepper pot skull
128
diagnosis of hyperparathyroidism
DEXA scan for osteopenia/osteoporotic risk high calcium with tertiary
129
treatment of primary and secondary hyperparathyroidism
surgery to remove tumour
130
treatment of tertiary hyperparathyroidism
surgery to remove parathyroid gland
131
pathology of secondary hyperparathyroidism
increased PTH secretion to compensate for prolonged hypocalcaemia
132
pathology of tertiary hyperparathyroidism
development of parathyroid hyperplasia after long-standing hyperparathyroidism loss of negative feedback
133
cause of hypoparathyroidism
autoimmune
134
signs of hypoparathyroidism
hypocalcaemia Trousseau's sign Chvostek's sign
135
symptoms of hypoparathyroidism
tetany
136
diagnosis of hypoparathyroidism
serum calcium (low) serum albumin PTH
137
treatment of hypoparathyroidism
calcium gluconate | calcitriol
138
treatment of serotonin producing neuroendocrine tumour
octreotide (somatostatin analogue)
139
risk factors for thyroid cancer
radiation exposure at young age (causes DNA damage) enlarged thyroid family history female
140
signs of thyroid cancer
``` neck pain and voice change (due to compression of recurrent laryngeal nerve) symptoms of hyper/hypothyroidism thyroid nodules (worrying if patient is under 20 as benign tumour unlikely) ```
141
diagnosis of thyroid cancer
USS fine needle aspiration measure TSH
142
treatment of thyroid cancer
``` radiation therapy (radioactive iodine) chemotherapy thyroid hormone therapy targeted therapy surgical removal followed by hormone replacement therapy ```

phase2a medicine (53 decks)

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