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Phase 2a Concise > Endocrinology > Flashcards

Endocrinology Flashcards

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1
Q

acromegaly Cx

A

HTN, LVH, IHD, diabetes, sleep apnoea, arthritis, bitemporal hemianopia from pituitary tumour

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2
Q

adrenal insufficiency overview

A

primary AI - impairment of adrenal cortex - low cortisol/aldosterone

secondary AI - low cortisol from low ACTH

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3
Q

AI presentation

A

tanned, tired, toned, tearful

signs

  • vitiligo
  • tanned skin
  • pigmentation (face, neck, palmar creases) - primary AI
  • hypotension - loss of aldosterone
  • dehydrated
  • lean

symptoms

  • lethargy, depression
  • dizzy
  • weight loss
  • nausea/vomiting
  • diarrhoea, constipation, abdo pain
  • impotence/amenorrhea
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4
Q

Conn’s DDx

A

secondary hyperaldosteronism - excess renin and AgII release (renal artery stenosis can cause this)

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5
Q

Cushing’s syndrome overview

A

excess cortisol

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6
Q

Cushing’s disease overview

A

excess cortisol from inappropriate ACTH secretion - pituitary adenoma

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7
Q

Cushing’s Ix

A

Dexamethasone suppression test - usually suppresses cortisol level - failure to suppress is diagnostic

CT/MRI of adrenals/pituitary

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8
Q

DM Ix

A

random plasma glucose >11.1mmol/L

fasting plasma glucose >7mmol/L

OGTT >7mmol/L (>6 for impaired glucose tolerance)

HbA1c >6.5% normal (48mmol/mol)

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9
Q

Which T2DM drugs cause weight loss/gain?

A

Biguianide (metformin) - reduce glycogenolysis, gluconeogenesis, increase muscle uptake of glucose - weight loss

Sulfonylurea (gliclazide) - stimulate insulin release - weight gain, hypo risk

DPP4 inhibitors (sitagliptin) - no weight change

Glitazone (pioglitazone) - weight gain

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10
Q

DM complications

A

Macrovascular - atherosclerosis, stroke, IHD, PAD

Microvascular - diabetic retinopathy, nephropathy, neuropathy, infections

DKA, HHS, hypoglycaemia

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11
Q

DKA causes

A

Lack of insulin, glucose cannot be taken up by cells

FFAs -> acetyl-coA -> ketone bodies

excessive ketonegenesis

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12
Q

HHS/DKA differentials

A

HHS - hypovolaemia, marked hyperglycaemia without acidosis, higher osmolality

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13
Q

Hypoglycaemia

A

plasma glucose <3mmol/L

insufficient glucose to brain

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14
Q

Thyroid carcinoma Mx

A

Radioactive iodine

Levothyroxine (T4) - keep TSH reduced

Chemo

Partial/full thyroidectomy

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15
Q

Hypercalcaemia presentation

A

symptoms
bones - excess bone resorption - pain, fractures, osteoporosis
stones - biliary stones
groans - abdo pain, malaise, polydipsia, nausea
psychiatric moans - depression, anxiety

signs
QT shortening

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16
Q

Hypoparathyroidism

A

Low PTH

Primary - low due to parathyroid gland failure

Secondary - after parathyroidectomy/thyroidectomy

Pseudo - failure of target cell response to PTH

Pseudopseudo - same as pseudo but no Ca abnormalities

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17
Q

Hypoparathyroidism Ix

A

Bloods - calcium low, PTH low (high in pseudo)

ECG - long QT

Parathyroid ABs

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18
Q

SIADH Ix

A

FBC, U+E

Hyponatraemia, low plasma osmolality, high urine osmolality

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19
Q

acromegaly overview

A

excess growth hormone -> overgrowth of all organ systems

gigantism in children

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20
Q

acromegaly causes

A

pituitary adenoma secreting too much GH

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21
Q

acromegaly presentation

A

signs

  • big hands, feet, jaw
  • acral and soft tissue overgrowth
  • big tongue, widely spaced teeth
  • coarse facial features
  • prognathism

symptoms

  • arthralgia
  • acroparaesthesia
  • headache
  • decreased libido
  • acral enlargement
  • wonky bite (malocclusion)
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22
Q

acromegaly DDx

A

pseudo-acromegaly - same physical appearance without elevated GH/IGF-1

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23
Q

acromegaly Ix

A

check IGF-1 levels (not GH, is pulsatile secretion)

oral glucose tolerance test - normally, rise in blood glucose suppresses GH levels

MRI pituitary fossa for adenomas

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24
Q

acromegaly Tx

A

transsphenoidal surgery

somatostatin analogues (IM octreotide)
dopamine agonist (oral cabergoline)
GH antagonist (pegvisomant)

radiotherapy

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25
AI causes
primary - worldwide, TB - in UK - autoimmune adrenalitis (Addison's disease) - adrenal metastases, long term steroid use, opportunistic infections secondary - long term steroid therapy - hypothalamic-pituitary disease - tumours, trauma, surgery
26
AI Ix
Bloods - hyponatraemia, hyperkalaemia (low aldosterone), hypoglycaemia (low cortisol) Synacthen test measure plasma cortisol before/30min after IM tetracosactide (ACTH analogue), cortisol remains low in primary AI, increases in secondary Adrenal ABs - 21 hydroxylase AB in Addisons AXR/CXR
27
AI Tx
primary acute - IV hydrocortisone, saline, glucose infusion ``` oral hydrocortisone/prednisolone (glucocorticoids) oral fludrocortisone (mineralocorticoid) ``` secondary oral hydrocortisone
28
AI Cx
Adrenal crisis - acute lack of cortisol (tx hydrocortisone) Reduced QoL Osteoporosis (from regular steroids)
29
Conn's syndrome overview
primary hyperaldosteronism excess aldosterone production -> increased sodium, water retention
30
Conn's causes
2/3 - adrenal adenoma 1/3 - bilateral adrenocortical hyperplasia
31
Conn's presentation
Often asymptomatic Hypertension Metabolic alkalosis Hypokalaemia - weakness/cramps, paraesthesia, polyuria/polydipsia
32
Conn's Ix
U/E Spot renin/aldosterone levels - aldosterone raised, renin low ECG - hypokalaemia CT/MRI adrenals
33
Conn's Mx
Aldosterone antagonist - oral spironolactone Laproscopic adrenalectomy
34
Conn's Cx
Cx from HTN - stroke, MI, kidney failure
35
Cushing's syndrome causes
ACTH-dependent (high ACTH) Cushing's disease - ACTH-secreting pituitary tumour ACTH-producing tumour elsewhere ACTH-independent (low ACTH due to -ve feedback from raised cortisol) adrenal tumour releasing cortisol oral steroids
36
Cushing's presentation
``` CUSHING Cataracts Ulcers Skin - striae Hypertension, hyperglycaemia Infections increase Necrosis Glucosuria ``` ``` Central obesity, wasted limbs Moon face Buffalo hump Acne, hirsuitism, weight gain Mood change, gonadal dysfunction, protein wasting ```
37
Cushing's DDx
Pseudo-Cushing's - same presentation, not from pituitary-adrenal axis problems - eg prolonged excess alcohol consumption
38
Cushing's Tx
Cushing's disease - transphenoidal removal of pituitary adenoma Adrenal adenoma - adrenalectomy Adrenal carcinoma - radiotherapy, adrenolytic drugs (mitotane) Ectopic ACTH - surgery if tumour located, drugs that inhibit cortisol synthesis (metyrapone, fluconazole)
39
Cushing's Cx
HTN, metabolic syndrome, diabetes, obesity, coagulopathy, osteoporosis, Nelson's syndrome
40
Nelson's syndrome
increase skin pigmentation from ACTH increase from enlarging pituitary tumour after adrenalectomy (remove negative feedback against ACTH)
41
Diabetes mellitus
deficiency/diminished effectiveness of insulin, hyperglycaemia
42
T1DM
body fails to produce sufficient insulin prone to DKA
43
T2DM
resistance to insulin
44
Gestational diabetes
high blood glucose levels in pregnancy
45
Maturity-onset diabetes of the young (MODY)
autosomal dominant form of T2DM - single gene defect altering beta cell function
46
secondary diabetes
inc pancreatic disease, endocrine...
47
T1DM causes
autoimmune idiopathic genetic component
48
T2DM causes
decreased insulin secretion/increased resistance obesity, lack of exercise, calorie excess polygenic
49
T1DM risk factors
Northern European, family history, other autoimmune disorders
50
T2DM risk factors
FHx, increasing age, obesity, poor exercise, ethnicity, overweight around abdomen
51
DM presentation
signs ketonuria (ketoacidosis) - pear drop breath (T1) complications (eg retinopathy) symptoms polyuria/nocturia polydipsia weight loss T1 - leaner than T2
52
T1DM Mx
synthetic human insulin short acting insulins - eg for before meals sort-acting insulin analogues - fast onset, eg with evening meal longer-acting insulins - 12-24hrs complications - hypoglycaemia, weight gain
53
T2DM Mx
1st line - lifestyle - diet, exercise, weight loss, ramipril/statins/orlistat 2nd - oral metformin Add sulfonylurea (oral gliclazide) later - insulin/glitazone (oral pioglitazone) - increase tissue sensitivity to insulin
54
DKA overview
Ketonaemia (/ketonuria) Hyperglycaemia Acidosis
55
DKA presentation
signs Pear drop breath Kussmaul's respiration (deep, rapid) Disturbance of consciousness ``` symptoms Vomiting Drowsiness Abdo pain Dehydration - eyes sunken, slow cap refill, tachycardia, weak pulse, hypotension ```
56
DKA DDx
alcoholic ketoacidosis, hyperosmolar hyperglycaemic state, lactic acidosis
57
DKA Ix
Bloods show: hyperglycaemia, raised plasma ketones, acidaemia, metabolic acidosis with bicarb reduced Urine stick testing - glycosuria and ketonuria Check plasma osmolality and anion gap (both elevated, plasma osmolality more elevated in HSS)
58
DKA Tx
ABCDE Replace fluid loss with 0.9% saline Restore electrolye (K) loss and acid-base balance Insulin-glucose
59
DKA Cx
Cerebral oedema, pulmonary oedema, hypotension, coma, hypothermia...
60
Hyperosmolar Hyperglycemic State (HHS)
Acute Hyperglycaemia, hyperosmolality, mild/no ketoacidosis
61
HHS causes
Uncontrolled T2DM
62
HHS presentation
``` signs dehydration reduced consciousness bicarb not lowered tachycardia, hypotension ``` symptoms generalised weakness nausea/vomiting bed-bound, confused, lethargic
63
HHS Ix
Hyperglycaemia Urine stick - glycosuria Plasma osmolality high
64
HHS Tx
Fluids - saline Insulin LMWH - eg enoxaparin - reduce risk of thromboembolism Restore electrolyte loss (K)
65
HHS Cx
Ischaemia/infarction, vascular cx, ARDS, cerebral oedema (rapid lowering of blood glucose)
66
Hyperthyroidism
Excess TH Primary - pathology in thyroid gland Secondary - thyroid gland stimulated by excessive TSH
67
Primary hyperthyroidism causes
Graves disease - autoimmune induced excess TH secretion, diffuse goitre, Toxic multinodular goitre - nodules that secrete TH Adenoma Thyroiditis (De Quervain's) - transient, inflammation of thyroid Drug-induced - amiodarone, iodine, lithium
68
Secondary hyperthyroidism causes
TSH-secreting pituitary adenoma TH-resistance syndrome Gestational thyrotoxicosis
69
Hyperthyroidism presentation
``` signs Graves ophthalmopathy - retro-orbital inflammation, protruding eye diffuse goitre hyperkinesis muscle wasting thin hair lid lag and stare, lid retraction onycholysis (nail separation from nail bed) ``` ``` symptoms palpitations diarrhoea weight loss oligomenorrhea heat intolerance irritability/anxiety ```
70
Hyperthyroidism Ix
TFTs - T4/3 raised (TSH raised in secondary) ABs against thyroid peroxidase and thyroglobulin (Graves) Ultrasound thyroid, thyroid uptake scan inflammatory markers TSHR-Ab raised - diagnostic of Graves
71
Hyperthyroidism Tx
(IV methylprednisolone - for inflammation) BBs (propanolol) PTU (propylthiouracil) - stops T4 ->T3 Oral carbimazole - blocks TH synthesis - AGRANULOCYTOSIS risk (sore throat, fevers) Radioactive iodine Thyroidectomy
72
Thyroid crisis
acute complication - rapid T4 increase hyperpyrexia, tachycardia... precipitated by stress Tx - oral carbimazole, oral propranolol, oral potassium iodide, IV hydrocortisone
73
Hypoglycaemia causes
In diabetics - insulin/sulfonylurea tx Non-diabetics - EXPLAIN Ex - exogenous drugs, insulin, alcohol P - pituitary insufficiency L - liver failure A - Addison's disease (lack of anti-insulin hormone function) I - islets cell tumour, immune hypoglycaemia N - non-pancreatic neoplasm
74
Hypoglycaemia presentation
Sweating, anxiety, hunger, tremor, palpitations, dizziness Confusion, drowsiness, visual trouble, seizures, coma (neuroglycopenia)
75
Hypoglycaemia Ix
Fingerprick blood test Bloods - glucose, insulin, C-peptide, plasma ketones
76
Hypoglycaemia Mx
Oral sugar, long-acting starch IV glucose 50% IM glucagon
77
Hypothyroidism
Lack of TH Primary - thyroid gland disease Secondary - hypothalamic/pituitary disease
78
Hypothyroidism causes
Autoimmine - antithyroid autoantibodies - atrophy, no goitre Thyroiditis (Hashimoto's - is autoimmune) - atrophy, goitre Post-partum thyroiditis Thyroidectomy/radioactive iodine Drug-induced - carbimazole, lithium, amiodarone Iodine deficiency
79
Hypothyroidism presentation
``` signs - BRADYCARDIC Bradycardia Reflexes relax slowly Ataxia Dry, thin hair/skin Yawning/drowsy/coma Cold hands/temp drop Ascites Round puffy face Defeated demeanour Immobile/ileus (peristalsis stops) CCF ``` ``` symptoms hoarse voice goitre constipation cold intolerant weight gain myalgia low mood hair/eyebrow loss cold pale skin ```
80
Hypothyroidism Ix
TFTs - TSH high in primary, low in secondary, T4 low Bloods - anaemia...
81
Hypothyroidism Tx
Oral levothyroxine (T4)
82
Myxoedema coma
Severe hypothyroidism, acute emergency hypothermia, cardiac failure, hypoventilation, hypoglycaemia, hyponatraemia IV/oral T3 and glucose infusion
83
Thyroid carcinoma
Papillary - local spread Follicular - spread to lung/bone Anaplastic - aggressive Lymphoma - non-Hodgkins Medullary cell - calcitonin C cells
84
Thyroid carcinoma presentation
signs thyroid nodule cervical lymphadenopathy symptoms dysphagia, hoarseness of voice
85
Thyroid carcinoma Ix
Fine needle aspiration cytology biopsy Bloods - TFTs Ultrasound thyroid
86
Diabetes insipidus
Hyposecretion/insensitivity to ADH Passage of large volumes of dilute urine Cranial DI - reduced ADH secretion from pos pit Nephrogenic DI - impaired response of kidney to ADH
87
Hyposecretion/insensitivity to ADH Passage of large volumes of dilute urine Cranial DI - reduced ADH secretion from pos pit Nephrogenic DI - impaired response of kidney to ADH
Cranial Genetics, hypothalamus disease, tumour, trauma Nephrogenic Hypokalaemia, hypercalcaemia, CKD, drugs, renal tubular acidosis, mutation of ADH receptor, pregnancy
88
DI presentation
signs 24hr urinary collection >3L/24hr symptoms polyuria polydipsia, chronic thirst nocturia
89
DI Ix
24hr urine collection test Fluid deprivation test - restrict fluid, measure urine osmolality - if low then DI Desmopressin: High urine osmolality - cranial DI Low - nephrogenic DI MRI pituitary, hypothalamus
90
DI Tx
Cranial - oral desmopressin Nephrogenic - treat cause, thiazide diuretics (oral bendroflumethiazide) - produce mild hypovolaemia, encourage kidneys to reabsorb Na and water, NSAIDs (ibuprofen) - lower urine vol and plasma Na
91
Hypercalcaemia
High Ca serum levels
92
Hypercalcaemia causes
Primary hyperparathyroidism Malignancy - ectopic production of PTH-related peptide, osteolytic hypercalcaemia
93
Hypercalcaemia Ix
Raised corrected calcium levels PTH low in cancer, high in primary hyperparathyroidism Low albumin 24hr urinary Ca, ECG, CT/MRI
94
Hypercalcaemia Tx
Rehydrate with saline Bisphosphonates - prevent bone resorption - IV pamidronate Oral prednisolone
95
Hypercalcaemia Cx
Osteoporosis, kidney stones, renal failure, abnormal heart rhythm, nervous system problems
96
Hyperparathyroidism
Too much PTH secretion Primary - parathyroid gland makes too much PTH Secondary - increased PTH secretion in response to low calcium Tertiary - autonomous secretion of PTH
97
Hyperparathyroidism causes
Primary - adenoma, hyperplasia Secondary - is compensation of hypocalcaemia (from CKD/vit D deficiency) Tertiary - after many years of secondary - CKD
98
Hyperparathyroidism presentation
primary bones, stones, groans, moans hypertension, short QT secondary like CKD - skeletal/CV complications tertiary like primary
99
Hyperparathyroidism Ix
Bloods - PTH, calcium, phosphate, ALP PTH high in all Calcium high in 1, 3, low in 2 Phosphate high in 2, 3, low in 1 ALP high in all
100
Hyperparathyroidism Mx
Surgical removal Calcimimetic - increases sensitivity of parathyroid to Ca, less PTH secretion - eg oral cinacalcet Bisphosphonates - alendronate - prevent loss of bone density
101
Hyperparathyroidism Cx
Hypocalcaemia, recurrent laryngeal nerve injury (from surgery)
102
Hypocalcaemia
Ca deficiency
103
Hypocalcaemia causes
HAVOC ``` Hypoparathyroidism Acute pancreatitis Vit D deficiency Osteomalacia CKD ```
104
Hypocalcaemia presentation
SPASMODIC ``` Spasms - Trousseau's sign Perioral paraesthesia (+cramps/tetany) Anxious, irritable, irrational Seizures Muscle tone increases in SM, wheeze Orientation impaired and confusion Dermatitis Impetigo herpetiformis Chvostek's sign, cataract, cardiomyopathy - long QT ```
105
Hypocalcaemia Ix
Low serum Ca Serum urine and creatinine, eGFR - test for renal disease ECG
106
Hypocalcaemia Mx
Acute - IV calcium gluconate Vit D deficiency - oral colecalciferol/ADCAL Hypoparathyroidism - calcium supplements + calcitriol (active vD)
107
Hypoparathyroidism causes
1 - parathyroid gland failure - autoimmune 2 - after (para)thyroidectomy, radiation, hypomagnesaemia Pseudo - end-organ resistance to PTH
108
Hypoparathyroidism presentation
SPASMODIC dry, scaly, puffy skin, brittle nails, coarse hair Pseudo - short stature, short 4/5 metacarpals, subcut calcification
109
Hypoparathyroidism Mx
Acute - IV calcium calcium supplements and calcitriol
110
Hypoparathyroidism Cx
Due to hypocalcaemia laryngospasms, neuromuscular irritability (cramps/tetany), arrhythmias, stunted growth...
111
Pheochromocytoma
Catecholamine secreting tumour
112
Pheochromocytoma causes
Inherited (more noradrenaline) Spontaneous (more adrenaline)
113
Pheochromocytoma presentation
``` signs hypertension postural hypotension tremor tachycardia ``` ``` symptoms headaches palpitations sweating tremor anxiety/nausea ```
114
Pheochromocytoma Ix
24hr urine collection for catecholamines and metabolites Blood tests CT/MRI - locate tumour
115
Pheochromocytoma Mx
Surgery Alpha blocker (phenoxybenzamine), beta blocker
116
Prolactinoma
benign, prolactin-producing tumour of pituitary gland
117
Hyperprolactinaemia causes
pituitary tumour antidopaminergic drugs, antidepressants head injury
118
Prolactinoma presentation
Tumour - headaches, bitemporal hemianopia menstrual irregularity infertility galactorrhoea hypogonadism
119
Prolactinoma Ix
check serum prolactin levels
120
Prolactinoma Tx
dopamine agonist - cabergoline transsphenoidal pituitary resection
121
Prolactinoma Cx
Vision loss, osteoporosis (from hypogonadism)
122
Carcinoid tumours
Tumours of neuroendocrine/enterochromaffin cells - secrete serotonin/bradykinin In gut, gallbladder, kidney ...
123
Carcinoid syndrome
hepatic involvement of carcinoid tumours
124
Serotonin effects
``` bowel function mood clotting nausea bone density vasoconstriction increase force of contraction and HR ```
125
Carcinoid tumours presentation
Most asymptomatic, maybe weight loss, pain, palpable mass signs CCF ``` symptoms neck/face flushing bronchocontriction/bronchospasm appendicitis/obstruction RUQ pain diarrhoea ```
126
Carcinoid tumours Ix
Liver ultrasound Urine - high conc of 5-hydroxylindoleacetic acid (metabolite of serotonin) X-ray/CT/MRI
127
Carcinoid tumours Mx
Octreotide/lanreotide - somatostatin analogs - block serotonin release Surgical resection
128
Carcinoid crisis
Tumour outgrows blood supply/is handled too much in surgery - mediators flow out Tx - octreotide high dose
129
Hyperkalaemia
Serum K >5.5mmol/L
130
Hyperkalaemia causes
Renal - AKI, CKD, K-sparing diuretics, drugs that interfere with RAAS (NSAIDs) Increased circulation of K - exogenous/endogenous - eg trauma, mass loss of K from cells Shift from IC to EC space - acidosis, medications Pseudo - eg tourniquet on too long
131
Hyperkalaemia presentation
Cardiac arrest might be first presentation Maybe associated with metabolic acidosis signs bradycardia, tachypnoea muscle weakness, flaccid paralysis depressed tendon reflexes symptoms weakness, fatigue, muscular paralysis, SOB, palpitations/chest pain
132
Hyperkalaemia Ix
Bloods - high K ECG - absent P, long PR, wide QRS, tall tented T - go, go long, go wide, go tall = gonner, sine wave pattern
133
Hyperkalaemia Mx
IV calcium gluconate - reduces excitability of cardiac myocytes Insulin-glucose infusion - drive K into cells Non-urgent - calcium polystyrene sulfonate resin - reduces K gut uptake
134
Hypokalaemia
Serum K <3.5mmol/L
135
Hypokalaemia causes
Increased renal secretion - thiazide/loop diuretics, increased aldosterone secretion (Cushing's/Conn's) Exogenous mineralocorticoids Redistribution to cells GI losses Reduced dietary intake/inadequate K replacement in fluids
136
Hypokalaemia presentation
usually asymptomatic ``` signs muscle weakness hypotonia hyporeflexia tetany ``` ``` symptoms constipation palpitations light-headedness cramps ```
137
Hypokalaemia Ix
Bloods - low serum levels ECG - small/inverted T waves, ST depression, U waves (PR prolongation)
138
Hypokalaemia Mx
Treat underlying cause mild - oral K supplements (oral Sando-K) Severe - IV K
139
SIADH
Syndrome of inappropriate secretion of ADH too much ADH dilute plasma, excess BV, hyponatraemia
140
SIADH causes
Neurological - eg trauma, tumour Pulmonary - cancer, pneumonia... Malignancy Drugs - thiazide diuretics, SSRIs, PPIs
141
SIADH presentation
signs GCS reduction, confusion, drowsiness fits/coma concentrated urine symptoms anorexia/nausea, malaise weakness/aches
142
SIADH Tx
Underlying cause, restrict fluids Hypertonic saline Oral tolvaptan - vasopressin antagonist Salt and loop diuretic - oral furosemide - if severe
143
SIADH Cx
Cx of hyponatraemia - gait disturbance, falls, cerebral oedema

Phase 2a Concise (9 decks)

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