Endocrine - investigations and treatments Flashcards
(127 cards)
1
Q
main antibody in graves
A
anti-TSH
2
Q
symptomatic control of hyperthyroid
A
propranolol
3
Q
main treatment of hyperthyroid
A
carbimazole
4
Q
main risk of carbimazole use
A
agranulocytosis
5
Q
tx hyperthyroid in 1st trimester of pregnancy
A
propylthiouracil
6
Q
tx hyperthyroid in 2nd and 3rd trimester pregnancy
A
carbimazole
7
Q
usual regime of carbimazole
A
started at 40mg then reduced gradually, continued for 12-18 months
8
Q
tx thyroid storm
A
Iv propranolol
IV dexamethasone
carbimazole or PTU
9
Q
antibody in hashimotos
A
anti-TPO
anti-Tg
10
Q
tx hypothyroidism
A
levothyroxine
young - 50-100mcg
older - 25-50mcg
11
Q
when should thyroid hormones be checked following a change in thyroxine
A
after 8-12 weeks
12
Q
how much should levothyroxine be increased in pregnancy
A
by 25-50 mcg
13
Q
advice for patient if taking levothyroxine with iron or calcium
A
take at least 4 hours apart
levothyroxine must also be taken 30 mins before food
14
Q
tx myxoedema coma
A
IV levothyroxine
IV fluids
IV steroids (due to possibility of co-existing adrenal insufficiency)
15
Q
TSH and T4 seen in
primary hyperthyroidism
A
high T4
low TSH
16
Q
TSH and T4 seen in
secondary hyperthyroidism
A
high T4
high TSH
17
Q
TSH and T4 seen in
subacute hyperthyroidism
A
low TSH
normal T4
18
Q
scintigraphy uptake seen in toxic adenoma
A
single nodule of high uptake
19
Q
scintigraphy uptake seen in de quervians
A
globally reduced uptake
20
Q
scintigraphy uptake seen in graves
A
diffuse increased uptake
21
Q
scintigraphy uptake seen in toxic multinodular
A
high patchy uptake in multiple locations
22
Q
phases of de quervians
A
phase 1 - hyperthyroid- 3-6 weeks
phase 2 euthyroid 1-3 weeks
phase 3 hypothyroid (weeks - months)
phase 4 normal
23
Q
tx de quervians
A
self limiting
NSAID if painful goiture
24
Q
TSH and T4 in primary hypothyroid
A
t4 low
tsh high
25
TSH and T4 in secondary hypothyroid
low TSH
| low t4
26
TSH and T4 in subclinical hypothyroid
normal T4
| high TSH
27
TSH and T4 in sick euthyroid
low TSH
| low T4
28
TSH and T4 in poor compliance with thyroxine
high TSH
| high T4
29
phases of post-partum thyroiditis
thyrotoxicosis
hypothyroid
normal
30
treatment of post-partum thyroiditis
thyrotixic phase- propranolol
| hypothyroid phase - thyroxine
31
gold standard investigation for thyroid cancer
US guided FNA
32
tx thyroid cancer
thyroidectomy + radio-ablation
33
tx thyroid cancer if low risk, < 50 < 4cm
lobectomy
34
what monitoring is required in thyroid cancer
yearly thyroglobulin
35
grading of thyroid cancer from USS
U2 - benign
U3 - atypical
U4 - probably malignant
U5 - malignant
36
grading of thyroid cancer from FNA
```
Thy1 - inadequate
Thy2 - benign
Thy3 - atypical
Thy 4 - probably malignant
Thy 5 - malignant
```
37
dx of osteoporosis
DEXA scan < -2.5
38
DEXA scan osteopenia
-1 to -2.5
39
normal BMD on DEXA
above -1
40
1st line tx osteoporosis
bisphosphonates - alendronate, risedronate
41
when are bisphosphonates taken
once a week with large glass of water and sitting up for at least 30 minutes
42
tx osteoporosis if cant tolerate bisphosphonates
if cant tolerate alendronate due to GI symptoms try another bisphosphonate
if cant tolerate any bisphosphonates - strontium ranelate
43
tx osteoporosis if no response to bisphosphonate or strontium
SC teriparatide
44
as well as bisphosphonates what should osteoporosis management include
vitamin D and calcium supplements
45
bloods of pagets disease of the bone
| ALP, ca, phos
increase ALP
| normal calcium and phosphate
46
tx pagets
analgesia
| bisphosphonates
47
lack of vitamin D leads to what bone problem in
- children
- adults
rickets
| osteomalacia
48
pathophysiology in renal bone disease
damaged kidneys excrete less phosphate --> hyperphosphataemia and hypocalcaemia
reduced vit D activation by kidneys also leads to hypocalcaemia
hypocalcaemia leads to secondary hyperparathyroidism --> high PTH
49
bloods of osteomalacia caused by vitamin D deficiecny
```
hypocalcaemia
hypophosphataemia
low vitamin D
high ALP
high PTH
```
50
blood of osteomalacia caused by renal bone disease
hypocalcaemia
hyperphosphataemia
high ALP
high PTH
51
differentiating feature of osteomalacia caused by RBD and low vit D
RBD - high phosphate
vit D deficiency - low phosphate
52
tx osteomalacia cause by vitamin D deficiency
calcium / Vitamin D supplements- calcium D3
53
1st line treatment osteomalacia by RBD
reduce dietary intake of phosphate
54
2nd line treatment of osteomalacia by RBD
phosphate binders - sevelamer
| vitamin D - alfacalcidol, calcitrol
55
ix primary hyperparathyroidism
24 hour urinary calcium - high
56
bloods of primary hyperparathyroidism
PTH raised or inappropriately normal (should be low given high Ca)
hypercalcaemia
hypophosphataemia
57
definitive tx primary hyperparathyroidism
total parathyroidectomy
| not definitive - but watchful waiting if no evidence of organ damage/Ca not too high
58
tx primary hyperparathyroidism if not suitable for surgery
cinacalcet ( calcium mimetic)
59
bloods of secondary hyperparathyroidism
low Ca
high PTH
high phosphate
normal response of parathyroid gland to low calcium
60
bloods of tertiary hyperparathyroidism
high calcium
high PTH
prolonged hypocalcaemia leads to parathyroid hyperplasia
61
what cancers can release PTHrp
squamous cell lung
renal
breast
62
bloods of paraneoplastic PTHrp
high Ca
| low PTH
63
bloods of primary hypoparathyroidism
low ca
low PTH
high Phosphate
64
tx primary hypoparathyroidism
alfacalcidol
65
bloods of pseudo-hypoparathyroidism
low Ca
high phosphate
high PTH
66
dx of hypoparathyroidism
measure urinary cAMP and phosphate after infusion of PTH
primary hypoparathyroidism - increase in both
pseudo type 1 - neither increases
pseudo type 2 - only cAMP rises
67
what is pseudo pseudo hypoparathyroidism
morphological features of pseudo hypoparathyroidism but bloods normal
68
tx pseudo and pseudopseudo hypoparathyroidism
calcium and vit D supplemetns
69
ix of familial hypocalciuric hypercalcaemia
urine calcium:creatinine clearance ratio
70
tx acute hypercalcaemia
```
IV fluids - normal saline
following rehydration IV bisphosphonates
calcitonin - quicker than bisphos
steroids
loop diuretics
```
71
tx hypocalcaemia acute
IV calcium gluconate 10ml 10% over 10 minutes
72
tx hypocalcacemia mild
calcium and vit D supplements
73
features of MEN 1
parathyroid hyperplasia
pituitary adenoma
pancreatic tumour
74
features of MEN 2a
medullary thyroid carcinoma
phaeochromocytoma
parathyroid hyperplasia
75
features of MEN 2b
medullary thyroid carcinoma
phaeochromocytoma
neuromas
marfanoid appearance
76
ix hypopituitarism
measure all pituitary hormones
insulin tolerance/stress test (gold standard)
- if CI e.g. IHD or epilepsy, can do glucagon stimulation test
77
test for ACTH deficiency
short synacthen test
78
imaging in pituitary disease
MRI
79
what does craniopharyngioma usually cause hormone wise
diabetes insipidus
80
1st line tx hyperprolactinaemia
cabergoline, bromocriptine
81
2nd line treatment hyperprolactinaemia
surgical excision if no success with medical treatment
82
1st line ix for acromegaly
serum IGF-1 levels
83
gold standard in confirming acromegaly
glucose tolerance test
84
1st line treatment acromegaly
transphenoidal surgery
85
2nd line treatment acromegaly
octreatide, sandostatin
or pegvisomant - doesnt shrink tumour, still need surgery if mass effect, once SC administration
86
1st line ix of DI
plasma and urine osmolalities
urine osmolality > 700 excludes DI
87
osmolality of Diabetes insipidus
low urine osmolality
high serum osmolality
peeing out all water
88
gold standard investigation for DI
water deprivation test
89
how do you differentiate nephrogenic and central DI
after water deprivation give ADH
- nephrogenic - no rise in urine osmolality
- central - rise in urine osmolality
90
tx central DI
desmopressin
91
tx nephrogenic DI
thiazide diuretic
92
sodium potassium and glucose levels in Addisons
low sodium
high K
low glucose
93
diagnostic test for addisons
short synacthen test
94
results of short synacthen test in addisons
no rise in cortisol after giving synthetic ACTH
95
test for addisons if short synacthen test not available
9am cortisol level - will be low
96
tx addisons
fludrocortison + hydrocortisone
97
how is addisons treatment given
divided dose, in first part of day
98
what should patients be told about their steroid doses in sickness
double hydrocortisone for a week
fludrocortisone stays same
if vomiting replace with IM
99
tx addisonian crisis
fluid resus - saline or dextrose if hypoglycaemia
| IV hydrocortisone STAT
100
what acid base problem dose addisons causes
hyperkalaemic metabolic acidosis
101
aldosterone
cortisol
androgen
levels in addisons vs bilateral adrenal hyperplasia
addisons - all low
bilateral adrenal hyperplasia - increased androgen, reduced aldosterone, reduced cortisol
102
addison features but no hyperpigmentation think...
secondary adrenal insufficency e.g. pituitary or LT steroid - no build up of ACTH
103
1st line ix for hyperaldosteronism (primary = conns)
plasma aldosterone:renin ratio (high)
104
sodium and potassium in hyperaldosteronism
high sodium
| low potassium
105
ix of hyperaldosteronism if confirmed with plasma aldosteronism:renin ratio
CT abdomen and adrenal vein sampling
106
saline suppression test results of aldosteronism
failure to suppress aldosterone by 50% following consumption of water
107
tx hyperaldosteronism
spironolactone
108
tx conns
spironolactone
| removal of adenoma
109
ix of cushings if pituitary problem
MRI
110
ix of cushings if adrenal problem
CT
111
what acid base problem does cushing cause
hypokalaemic metabolic alkalosis
| + hyperglycaemia
112
1st line ix to confirm cushings
overnight dexamethasone suppression test
113
1st line ix to localise cushings
plasma ACTH and cortisol at 9am and midnight
114
results of plasma ACTH and cortisol at 9am and midnight in ACTH dependent cause
elevated ACTH and cortisol
115
results of plasma ACTH and cortisol at 9am and midnight in ACTH independent cause
undetectable ACTH with raised cortisol
116
example of ACTH independent causes of cushings
adrenal adenoma / carcinoma
steroids
117
examples of ACTH dependent causes of cushings
pituitary adenoma
ectopic from small celll lung cancer
118
diagnostic test for cushings
48 hour high dose dexamethasone suppression test
119
results of 48 hour high dose dexamethasone suppression test in cushings disease i.e. pituitary adenoma
cortisol suppressed
| ACTH suppressed
120
results of 48 hour high dose dexamethasone suppression test in ACTH independent cause i.e. adrenal adenoma
cortisol not suppressed
| ACTH suppressed
121
results of 48 hour high dose dexamethasone suppression test in ectopic ACTH
neither cortisol or ACTH suppressed
122
ix if ectopic cause
CT CAP
123
tx of cushings disease
trans sphenoidal surgical excision of pituitary adenoma
124
tx cushings by adrenal adenoma
adrenectomy
125
ix pheochromocytoma
| - 1st line and type of scan
24 hour urine metanephrines
MIBG scan
126
tx phaeochromocytome
alpha blockade - phenoxybenzamine
then beta blockade - propanolol
then
surgical excision of tumour
127
tx hypertensive crisis in phaeochromocytoma
labetolol
