Endocrine notes Flashcards by Shubham Agwan

What kind of receptors do hormones bind to in order to bring about a specific response

Cognate receptors

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How is hormone action typically terminated

By enzyme-mediated inactivation in the liver

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What is the rate-limiting step in synthesis of steroid hormones

Conversion of Cholesterol to Pregnenolone

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Name 3 important carrier proteins and what they bind

Cortisol-binding-globulin (CBG)
Thyroxine-binding-globulin (TBG)
Sex steroid-binding-globulin (SSBG) - testosterone/ estradiol

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Name 2 general carrier proteins and what they bind

Albumin - many steroids + thyroxine

Transthyretin - thyroxine

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Name the 3 classes of nuclear receptor and what activates them

Class 1 - Steroids
Class 2 - Lipids
Hybrid class - T3

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What do PP cells of the pancreas islets release

Pancreatic Polypeptide

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What is Leprechaunism-Donohue syndrome

Mutations in the gene for insulin receptor

Cause growth retardation, muscle loss and fat loss

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Which three things are seen in Rabson Mendenhall syndrome

Severe insulin resistance
Hyperglycaemia
Hyerinsulinaemia

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Which derm condition can be seen in Rabson Mendenhall

Acanthosis Nigricans

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What chemical excess is converted to ketone bodies

Acetyl-CoA

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What are three useful tests to differentiate between Type 1 and Type 2 diabetes

Anti-GAD/ islet cell antibody test
Ketones
Plasma C-peptide

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Children diagnosed under the age of 6 are more likely to have which form of diabetes

Monogenic

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What is Bardet-Beidl syndrome

Genetic disorder with diabetes, obesity, retinitis pigmentosa, polydactyly, hypogonadism

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What are the 4 types of neuropathy

Peripheral
Autonomic
Proximal
Focal

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What is Kimmelstiel-Wilson syndrome

Diffuse scarring of glomeruli seen in long-standing diabetes

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What ratio is used to screen for nephropathy

Albumin-creatinine ratio (ACR)

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What is the main cause of death in children, secondary to DKA

Cerebral Oedema

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How is Hyperglycaemic Hyperosmolar syndrome

Hypovolaemia
Hyperglycaemia (BG > 30)
Hyperosmolar (osmolarity > 320)

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Where does GLP-1 act on in the brain

Hypothalamus

To reduce appetite

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What normally binds to the SUR1 subunit in a beta cell to open the K+/ATP channel

ADP-Mg2-

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How many micrograms of T3 equal 100 ug of T4

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What is struma ovarii

A teratoma containing thyroid tissue

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What is the treatment for thyroid storm

Lugol’s iodine
Steroids
B-blockers
Fluid

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Which drug can cause agranulocytosis

Carbimazole

Which cardio drug can cause thyroiditis

Amiodarone

When should you always treat subclinical hypothyroidism

In pregnancy | If TSH > 10

Which cells of the anterior pituitary release Prolactin

Lactotroph cells

What does AMES stand for with regard to thyroid cancer

Ages Mets Extent of primary tumour Size of primary tumour

What are the side effects of thyroid remnant ablation

Increased risk of AML(acute myelogenous leukaemia)

What drug treatments are available for Cushing's

Metyrapone (adrenal suppression) | Pasireotide (somatostatin analogue)

How is Diabetes Insipidus diagnosed

Water Deprivation test

How is diabetes insipidus treated

Desmopression (synthetic vasopressin)

What are some side effects of somatostatin analogues

Flatulence Diarrhoea Abdominal pain

Where is most Na in the body

Extra-cellular fluid

What values of sodium can be classed as hyper and hyponatraemia

<120 mmol/L = Hyponatraemia | >155 mmol/L = Hypernatraemia

What is the anterior pituitary derived from

Rathke's Pouch

Name the acidophil cells of the anterior pituitary

Somatotrophs (GH) | Mammotrophs (PRL)

Name the basophil cells of the anterior pituitary

Corticotrophs (ACTH) Thyrotrophs (TSH) Gonadotrophs (FSH/LH)

What are Zellballen

Tumour cells forming nests in a phaeochromocytoma

What are the tubular components of the testes

Sertoli cells | Germ cells

What are the interstitial components of the testes

Leydig cells | Capillaries

What is the treatment of Polycystic Ovarian Syndrome

Oral pill | Regulates cycle & decreases androgens

What is the scan used to image the parathyroid glands

Sestamibi scan

What values for serum calcium & eGFR indicate a need for parathyroidectomy

Calcium - > 2.85mmol/L | eGFR - < 60mL/min

What hypertension pattern would make you think of phaeochromocytoma

Labile hypertension - resistant to treatments | Postural hypotension

How does orlistat work

Pancreatic lipase inhibitor

Name an oral steroid with a relatively low mineralocorticoid activity

Dexamethasone

What does mineralocorticoid activity mean

Na retention in exchange for K+/H+ ions

What is the threshold for HbA1c which indicates adding a second oral therapy

58mmol/L

Which diabetes drug should be avoided in severe renal failure

Metformin

Which triad of symptoms suggests an Addisonian crisis

Hyponatremia Hyperkalaemia Hypoglycaemia

What should you think of if a patient presents with a tender goitre and thyrotoxicosis

De Quervain's thyroiditis

What is the 1st line treatment for cerebral metastases and why

Dexamethasone to decrease cerebral oedema

What are some side effects of radioiodine therapy for thyrotoxicosis

Hypothyroidism | Exacerbation of thyroid eye disease

What are the blood pressure targets for someone with diabetes ± end-organ damage

< 140/80 | < 130/80 if end-organ damage

Pioglitazone is contraindicated in heart failure, over 65's and which other PMH

History of bladder cancer

What is the most common cause of Addison's

Autoimmune Adrenalitis

How often should blood glucose be monitored in a type 1 diabetic

At least 4 times a day | Before each meal and before bed

Which thyroid pathology can have a 'rich lipid core'

Benign adenoma

Cushing's can put the body into what biochemical state

Hypokalaemic Metabolic Alkalosis

Which 3 hormones are decreased as part of the stress response

Insulin Testosterone Estrogen

What should be done to hydrocortisone and fludrocortisone doses on admission to hospital for an Addison's patient

Double Hydrocortisone | No change to Fludrocortisone

Which heart failure medication can cause hypercalcaemia

Thiazide diuretics

What does a High T4 and a High TSH suggest in a person on levothyroxine

Poor compliance -> they have taken extra levothyroxine before the review but the TSH hasn't had time to change

What is the pathology of Nelson's syndrome

Rapid enlargement of an ACTH producing pituitary adenoma following a bilateral adrenalectomy

Why would an arrhythmia arise in DKA

Hyperkalemia

What kind of iodine uptake is seen in De Quervain's thyroiditis

Decreased

What is the recommended insulin regime for a newly diagnosed type 1 diabetic

Basal-Bolus regime + long-acting insulin(detemir) twice daily

What should you think of when hypocalcaemia remains resistant to replacement therapy

Magnesium deficiency

What is the commonest cause of hypercalcaemia (and thus renal calculi)

Dehydration

What are the waking and pre-meal blood glucose targets for type 1 diabetics

4-7mmol/l for pre-meal | 5-7mmol/L for waking

3 Antibodies associated with type 1 diabetes

Anti GAD Anti IA2 Anti islet cell

Adrenaline, Cortisol and Glucagon are increased as part of the stress response. What two things are they trying to prevent

Hypoglycaemia | Hypokalaemia

How many ATP molecules can be produced from one glucose molecule

36 ATP molecules

What is the threshold after which beta cells physiologically begin releasing insulin

blood sugar over 5mmol/L

Which condition presents with severe insulin resistance and acanthosis nigricans

Rabson-Mendenhall syndrome

Insulin can be a hexamer or a monomer - which is the active form

Monomer

Which syndrome classically presents with very low muscle mass, growth retardation and severe insulin resistance

Donohue Syndrome

What is the normal level of 2-hour blood glucose for an oral glucose tolerance test

Less than or equal to 7.7mmol/l

What blood glucose after 2 hours will be diagnostic of diabetes in an Oral Glucose Tolerance Test

Greater than or equal to 11.1mmol/l

How might biochemistry results look like in anaemia in diabetes

Low albumin | Low Calcium

What are the two types of basal insulins

Isophane | Analogue

What is the target blood sugar level when a patient is on IV insulin and how often should this be checked

5-12mmol/l | Checked hourly

What happens to the efficacy of sulphonylureas as you increase the dose

Decreases

Metformin can interfere with the absorption of which two substances

Vit B12 | Folic Acid

What is the name given to the weakening of the legs seen in proximal neuropathy

Amyotrophy

What is the 1st line treatment for painful neuropathy

Duloxetine

What is the fluid treatment pathway for DKA

0.9% NaCl saline until glucose drops to 15 | then switch to dextrose

What should you give for alcohol-induced ketoacidosis

Pabrinex (high-dose vitamins)

What does carbimazole inhibit

Thyroid Peroxidase | prevents iodine binding to tyrosine residues to form MIT and DIT

Which hypothalamic secretion requires thyroid hormones to be present

GnRH

What kind of receptor is the TSH receptor

G-coupled

How does deiodinase work

Removes or adds an iodine atom from the outer ring of T3/4

What do T3 and T4 become after the action of deiodinase

T3 -> T2 | T4 -> rT3 (reverse)

What is the most active/abundant deiodinase and where are the others found

D2 (D1 -> kidneys & liver) (D3 -> placenta & brain)

What is a satisfactory level of serum GH after surgery

< 0.4 ug