Endocrinology Flashcards

Question

kallman's

Answer 1

- Low sex hormones, LH+FSH low/normal - Normal or tall - Anosmia - Delayed puberty due to hypogonadotropic hypogonadism

Answer 2

- 47xxy in men - Infertility, small testicles Low testosterone, high FSH & LH

Answer 3

- X-linked recessive - End ogran res to testosterone - Genotypically male children have a female phenotype

Answer 4

Diagnosed if either: • fasting glucose is >= 5.6 mmol/L • 2-hour glucose is >= 7.8 mmol/L Fasting plasma glucose level < 7: trial of diet and exercise ○ if glucose targets are not met within 1-2 wks: metformin ○ still not met: add insulin to diet/exercise/metformin (short-acting insulin) if at the time of diagnosis the fasting glucose level is >= 7 mmol/l insulin should be started if the plasma glucose level is between 6-6.9 mmol/l, and there is evidence of complications such as macrosomia or hydramnios, insulin should be offered

Answer 5

• Bloods: high PTH, high calcium, low phosphate • Urine calcium : creatinine clearance ratio > 0.01 Features: • Mild: can be asym • Recurrent abdo pain (pancreatitis, renal colic) • Changes to emotional or cognitive state Cause: • solitary adenoma (80%) • multifocal disease occurs in 10-15% and parathyroid carcinoma in 1% or less Indications for surgery • Elevated serum Calcium > 1mg/dL above normal • Hypercalciuria > 400mg/day • Creatinine clearance < 30% compared with normal • Episode of life threatening hypercalcaemia • Nephrolithiasis • Age < 50 years • Neuromuscular symptoms Reduction in bone mineral density of the femoral neck, lumbar spine, or distal radius of more than 2.5 standard deviations below peak bone mass (T score lower than -2.5)

Answer 6

• Bloods: high PTH, high phosphate, calcium low-normal, low vit D Features: Relatively asym >> bone disease, osteitis fibrosa cystica and soft tissue calcifications • Cause: Parathyroid gland hyperplasia as a result of low calcium, almost always with CKD • Tx: medical tx • Indications for surgery: bone pain, persistent pruritus, soft tissue calcifications

Answer 7

• Bloods: normal-high calcium, high PTH, high ALP, normal-low phosphate, normal-low vit D Features • Metastatic calcification • Bone pain and / or fracture • Nephrolithiasis • Pancreatitis Cause: a result of ongoing hyperplasia of the parathyroid glands after correction of underlying renal disorder, hyperplasia of all 4 glands is usually the cause Mx: wait a year after transplant as many self-resolve - The presence of an autonomously functioning parathyroid gland may require surgery ○ If the culprit gland can be identified then it should be excised. Otherwise total parathyroidectomy and re-implantation of part of the gland may be required.

Answer 8

Most important Ix for determining cause: PTH - normal or high PTH = primary hyperparathyroidism Two conds cause 90% • 1. Primary hyperparathyroidism: most common cause in non-hospitalised pts • 2. Malignancy: commonest cause in hospitalised patients ○ due to: bone mets, myeloma, PTHrP from squamous cell lung cancer Other causes include - sarcoidosis - vitamin D intoxication - acromegaly - thyrotoxicosis - Milk-alkali syndrome - drugs: thiazides, calcium containing antacids - dehydration - Addison's disease - Paget's disease of the bone

Answer 9

prevents PCSK9-mediated LDL rec degradation

Answer 10

- AD Mx Specialist lipid clinic High dose statins - high levels of LDL-cholesterol - if untreated > early CV disease - Cause: mutations in the gene which encodes the LDL-receptor protein.

Answer 11

``` • eye signs (30%) ○ exophthalmos ○ ophthalmoplegia • pretibial myxoedema • thyroid acropachy, a triad of: ○ digital clubbing ○ soft tissue swelling of the hands and feet periosteal new bone formation ``` Autoantibodies • TSH receptor stimulating antibodies (90%) • anti-thyroid peroxidase antibodies (75%) Thyroid scintigraphy: diffuse, homogenous, increased uptake of radioactive iodine

Answer 12

``` Causes of raised prolactin: the P's • prolactinoma • pregnancy • oestrogens • physiological: stress, exercise, sleep • acromegaly: 1/3 of patients • PCOS • primary hypothyroidism (due to thyrotrophin releasing hormone (TRH) stimulating prolactin release) ``` ``` Drug causes of raised prolactin • metoclopramide, domperidone • phenothiazines • haloperidol • very rare: SSRIs, opioids ```

Answer 13

Ass w dev of MALT lymphoma NOTES - Causes hypothyroid - But can be a transient hyperthyroid phase in acute phase Hypothyroid fts + firm painless goitre - Anti-TPO Abs, anti-thyroglobulin Abs Ass w other AI conditions (coeliac, T1DM, vitiligo) DETAILS = chronic autoimmune thyroiditis - 10x more in women More Presence of new thyroid mass on bg of longterm hashimoto's = MALT - Usually women 65-75y old - Usually neck lump w no other syms (can get dysphagia/dyspnoea from compression) - Dx: US + fine needle aspiration cytology

Answer 14

- serum osm >320 - Also: trace of ketones can be seen; glucose >30 The goals of management: - 1. Normalise the osmolality (gradually) ○ the serum osmolality is the key parameter to monitor ○ if not available it can be estimated by 2 * Na+ + glucose + urea - 2. Replace fluid and electrolyte losses ○ Intravenous (IV) 0.9% NaCl 1st line - 3. Normalise blood glucose (gradually) NB if no sig ketaemia: don’t start insulin Monitoring response to tx Rapid changes must be avoided. A safe rate of fall of plasma glucose of between 4 and 6 mmol/hr is recommended. The rate of fall of plasma sodium should not exceed 10 mmol/L in 24 hours.

Answer 15

Dx: supervised prolonged fasting (up to 72h) - If no option for this: insulin + c-peptide levels during an acute hypo High insulin High c-peptide Raised proinsulin: insulin ratio

Answer 16

``` Acute phase proteins • CRP • procalcitonin • ferritin • fibrinogen • alpha-1 antitrypsin • caeruloplasmin • serum amyloid A • serum amyloid P component • haptoglobin • complement ``` ``` Negative acute phase proteins • albumin • transthyretin (formerly known as prealbumin) • transferrin • retinol binding protein • cortisol binding protein ```

Answer 17

ECG: prolonged QT interval

Answer 18

- MX: IV Calcium gluconate 10ml of 10% over 10mins Causes: 1. Vit D def (osteomalacia) 2. CKD (increased serum phosphate) 3. Hypoparathyroid (eg post thyroid or parathyroid surgery) 4. Pseudohypoparathyroid (target cells insens to PTH) 5. Rhabdomyolysis (at the start) 6. Mg def (due to end organ PTH res) 7. Massive blood transfusion 8. Acute pancreatitis Features • tetany: muscle twitching, cramping and spasm • perioral paraesthesia • if chronic: depression, cataracts • ECG: prolonged QT interval • Trousseau's sign: carpal spasm if the brachial artery occluded by inflating the blood pressure cuff and maintaining pressure above systolic • Chvostek's sign: tapping over parotid causes facial muscles to twitch

Answer 19

- Due to sudden drop in prev high PTH levels - Leads to low calcium NOTES DETAILS - Uncommon - can occur after parathyroidectomy if the hyperparathyroidism has been long-standing. Mechanism: - high pre-operative levels of PTH > constant stimulus for osteoclast activity creating the hypercalcaemic state by de-mineralizing the bones. - This process can result in x-ray changes very similar to metastatic lytic lesions if left untreated. - Upon removal of the parathyroid adenoma > hormone levels fall rapidly (they have a very short half-life) > osteoclast activity is subsequently diminished > bones rapidly begin re-mineralisation - 'hungry bone syndrome'. This process can be uncomfortable and also result in systemic hypocalcaemia.

Answer 20

``` RAISED ALP • liver: cholestasis, hepatitis, fatty liver, neoplasia • Paget's • osteomalacia • bone metastases • hyperparathyroidism • renal failure • physiological: pregnancy, growing children, healing fractures ``` Raised ALP w raised calcium - Bone mets - Hyperparathyroidism Raised ALP w low calcium - Osteomalacia Renal failure

Answer 21

• Excessive exercise: hypothalamic hypogonadism (low oestradiol; FSH/LH low/normal) - secondary amenorrhoea Premature ovarian failure: high FSH/LH

Answer 22

Prolactin = under continuous inhibition by hypothal

Answer 23

nafld, pcos, raised uric acid levels

Answer 24

urgent review by an ophthalmologist: • unexplained deterioration in vision • awareness of change in intensity or quality of colour vision in one or both eyes • history of eye suddenly 'popping out' (globe subluxation) • obvious corneal opacity • cornea still visible when the eyelids are closed disc swelling

Endocrinology Flashcards

(50 cards)