Endocrinology Flashcards
(155 cards)
1
Q
what is meant by catabolic metabolism?
A
larger molecules are broken down into smaller ones
2
Q
What is meant by anabolic metabolism?
A
a larger molecule is made from smaller ones (e.g. storing)
3
Q
What does autocrine mean?
A
Acts on the same cell it was released from
4
Q
What does endocrine mean?
A
Acts on neighbouring cells
5
Q
What does exocrine mean?
A
enters the bloodstream and acts on distant cells
6
Q
What is meant by ‘neuroendocrine’?
A
neurons release hormones which enter the blood and travel to their target tissue
7
Q
What is meant by ‘total plasma hormone’?
A
Free hormone + protein bound hormone
8
Q
What connects the hypothalamus and the anterior pituitary?
A
capillary portal system
9
Q
Which hormones are secreted by the posterior pituitary?
A
Vasopressin and oxytocin
10
Q
Which part of the pituitary is an extension of neural tissue?
A
Posterior pituitary
11
Q
Name the amine hormones
A
Catecholamines (adrenaline, dopamine)
Thyroid hormones
12
Q
Name the steroid hormones
A
- Sex steroids
- HCG
- Corticosteroids
13
Q
What are steroid hormones derived from?
A
cholesterol
14
Q
What is a primary endocrine disorder?
A
disorder arising from a defect in the tissue that secretes that hormones
15
Q
What is a secondary endocrine disorder?
A
too much/too little from the pituitary
16
Q
What is a tertiary endocrine disorder?
A
Hypothalamic defect
17
Q
What are the growth drivers in infancy (0-2)?
A
Nutrition and insulin
18
Q
What are the growth drivers in childhood (3-11)?
A
Growth hormone and thyroxine
19
Q
What are the growth drivers in puberty (12-18)?
A
Growth hormones and sex steroids
20
Q
What is the first sign of puberty in girls?
A
breast budding (Tanner stage B2)
21
Q
What is the first sign of puberty in boys?
A
testicular enlargement (Tanner stage G2)
22
Q
What is the normal age of pubertal onset in boys?
A
9-14
(below 9 is precocious and above 14 is late)
23
Q
What is the normal age of pubertal onset in girls?
A
8-13
(below 8 is precocious and above 13 is late)
24
Q
Who is offered bariatric surgery?
A
a BMII ≥ 40
or
BMI ≥ 35 with 1 or more health problems that are likely to improve upon weight loss
25
which pancreatic cells produce glucagon?
alpha
26
which pancreatic cells produce insulin?
Beta
27
Which pancreatic cells produce somastatin?
D cells
28
What is c-peptide?
a by-product of insulin production
29
What effect does insulin have on the body?
causes cells to absorb glucose and use it as energy.
causes liver and muscle cells to take up glucose and store it.
30
What effect does glucagon have on the body?
causes the liver to break down glucose stores (glycogenolysis)
tells the liver to change fats and proteins into glucose (gluconeogenesis
31
What are the sick day rules for insulin?
Don’t ever stop insulin, check blood glucose levels more often.
32
When must the DVLA be informed with regards to diabetes?
if you have diabetes managed with medications
If on insulin and likely to be for >3 months
33
What are the rules regarding driving and long car journeys for those with diabetes?
BM must be checked before driving and every 2 hours whilst driving
Must not drive if BM <5
If BM falls below 5 while driving, you must wait for at least 45 minutes after your BM has surpassed 5mmol/L
34
What is a healthy, non-diabetic HBA1c?
<42
35
What is the target HBA1c in diabetics not on medications which carry a hypo risk?
48 or less
36
What is the target HBA1c in diabetics on medications which carry a hypo risk?
53
37
what causes T1DM?
Autoimmune destruction of the pancreas
38
What is MODY?
subset of T1DM occurring in older patients
39
How often to those with T1DM need to check fngerprick BM?
Finger prick a least 4x daily (before each meal and before bed)
40
How does c-peptide measure in T1DM?
Low
41
what causes T2DM?
peripheral tissues become insensitive to insulin (this is insulin resistance) & the pancreas loses its ability to secrete high levels of insulin
42
Explain the stepwise management of T2DM
Management is stepwise
Diet & exercise
Metformin
Dual therapy (metformin + 1 from table)
Triple therapy (metformin +2 from table)
43
What are the3 features of DKA
Ketoacidosis, dehydration, potassium imbalance
44
Which tests cane used to diagnose DKA?
* BM >11
* Ketones > 3
* pH < 7.3
45
What is the first line treatment of DKA?
Fluid
46
What must you be careful to avoid causing when treating DKA?
Cerebral oedema
47
What is the MOA of metformin?
Increases insulin sensitivity
Decreases glucose production by the liver
48
What are the side effects of metformin?
GI
Lactic acidosis secondary to AKI
49
What is the suffix of SGLT-2 medications?
-flozin
50
What is the MOA of SGLT-2 medications?
Increases urinary excretion of glucose
51
What are the side effects associated with SGLT-2 medications?
Hypoglycaemia & DKA
Weight loss
UTI/thrush/fournier’s
Lower limb amputation
52
What is the suffix associated with thiazolidinedones?
Increases insulin sensitivity
Decreases glucose production by the liver
53
What are the side effects associated with thiazolidinedones?
Weight gain
Heart failure
Bone fractures
Bladder cancer
54
What is the suffix of Sulfonylureas?
-zide
55
What is the MOA of Sulfonylureas?
Stimulates insulin release from the pancreas
56
What are the side effects associated with Sulfonylureas?
Weight gain
Hypoglycaemia
57
What is the suffix associated with DPP-4 inhibitors?
-gliptin
58
What is the MOA of DPP-4 inhibitors?
Incretin- Increase insulin secretion, inhibit glucagon production, slow absorption from GI tract
59
What are the side effects associated with DPP-4 inhibitors?
Headache
Pancreatitis
60
What is the suffix associated with GLP-1
-tide
61
What is the MOA of GLP-1?
Incretin- Increase insulin secretion, inhibit glucagon production, slow absorption from GI tract
62
What are the side effects associated with GLP-1?
Reduced appetite
Weight loss
GI
63
What is the first line antihypertensive in diabetics?
ACE inhibitors
64
What drug is given in diabetics with CKD if albumin: creatinine > 3mg/mmol
ACE inhibitor
65
What drug is given in diabetics with CKD if albumin: creatinine > 30mg/mmol
SGLT-2 inhibitor
66
Name the significant side effects of poorly controlled diabetes?
Vascular
* Retinopathy
* Nephropathy
* Neuropathy
Erectile dysfunction
Depression
67
What is the difference between cranial and nephrogenic diabetes insipidus?
Cranial DI = lack of antidiuretic hormone
Nephrogenic DI = lack of response to antidiuretic
68
What causes cranial diabetes insipidus?
Brain pathology
69
What causes nephrotic diabetes insipidus?
Lithium
High calcium
Low potassium
Polycystic kidney disease
70
How is diabetes insipidus diagnosed?
Water depravation test
71
In cranial diabetes inspidus, what result would you expect in
urine osmolality after water depravation
urine osmolality after desmopressin?
72
In nephrogenic diabetes inspidus, what result would you expect in
urine osmolality after water depravation
urine osmolality after desmopressin?
73
what is hyperosmolar, hyperglycaemic state?
Hyperosmolality
hyperglycaemia
absence of ketones
74
How is hyperosmolar, hyperglycaemic state managed?
IV fluids
75
Describe the hormonal axis for growth hormone
Growth hormone releasing hormone (stimulatory) Somatostatin (inhibitory)
->
Growth hormone (up or down regulated)
->
insulin-like growth factor-1 (IGF-1) from Liver
76
What are the functions of growth hormone?
Increases blood glucose
Promotes growth
77
What causes giantism?
Excessive growth hormone prior to closure of long bone epiphysis
78
What causes acromegally?
Excessive growth hormone after closure of long bone epiphysis
79
How is acromegaly diagnosed?
IGF-1 test then OGTT
80
What is the most common cause of excessive growth hormone resulting in acromegaly?
pituitary adenoma
81
How is a pituitary adenoma managed?
Trans-sphenoidal surgery
82
What is the first line medical management of acromegallY?
octerotide (somatostatin analogue)
83
describe the hormonal axis of sex hormones
Gonadotrophin releasing hormone
->
LH/FHS
->
oestrogen
84
Why do children that have gone through precocious puberty have stunted growth?
long bones fuse early under influence of sex hormones.
85
describe the hormonal axis of thyroid hormones
Thyrotropin releasing hormone
->
Thyroid stimulating Hormone
->
T3 & T4
86
Which thyroid cells secrete calcitonin?
clear cell
87
Which thyroid cells produce and secrete thyroid hormones?
Follicular cells
88
What are the functions of thyroid hormones?
Metabolism and thermogenesis
Growth
controlling heart, muscle and digestive function
brain development
bone maintenance
89
How can hyperthyroid be treated?
radioactive iodine
beta blockers (symptomatic)
antithyroid drugs (carbazole)
surgery
90
Name the two main hyperthyroid presentations
Graves
Toxic multinodular goitre
91
What antibodies are associated with Graves disease?
Anti-TSH & anti-TPO
92
How does graves disease present
Classic hyperthyroid signs +
Pre-tibial myxoedema
Exophthalmos
Diffuse goitre
93
What isotopic multi nodular goitre?
one or more nodules in the thyroid gland that make thyroid hormone without responding to the signal to keep thyroid hormone balanced
94
How does toxic multi nodular goitre look on nuclerscintigraphy?
Patchy uptake
95
How does thyroid storm (thyrotoxic crisis) present?
Fever
tachycardia
delirium
hyperthermia
96
What are the two big side effects of carbamazepine?
agranulocytosis and pancreatitis
97
What are the three main side effects of propyuracil?
severe liver reactions death
agranulocytosis
98
What causes hashimotos thyroiditis?
Autoimmune attack of the thyroid gland
99
What antibody is associated with hashimotos thyroiditis?
Anti-TPO
100
How is hashimotos managed?
Give titrated levothyroxine (when pregnant, double the dose on 2/7days)
101
What is the most common cause of hypothyroidism in the developing world?
Iodine deficiency
102
How much iodine is required per year by the body?
50mg
103
Name 3 foods high in iodine
milk, fish, seaweed
104
What is Sheehans syndrome?
Avascular necrosis of pituitary due to massive blood loss
105
What are the critical findings in myxoedema coma?
Critically low sodium
HYPOthermia
106
What is Subacute (de Quervain’s) thyroiditis?
Temporary inflammation of thyroid gland triggered by viral infection (e.g. enteroviruses, coxsackie)
Thyrotoxic phase for 3-6 weeks followed by a period of hypothyroidism for 3-6 months
107
what is the classic finding in subacute (De Quervains) thyroiditis?
PAINFULL goitre
108
how is subacute (De Quervains) thyroiditis managed?
It itself limiting so treat symptoms
NSAIDs for goitre inflam
B-Blockers for thyrotoxic phase
Levothyroxine for hypothyroid phase
109
What is the most common type of thyroid cancer?
Papillary
110
describe the hormonal axis of parthyroid hormones
Serum calcium/phosphate/magnesium levels
->
parathyroid hormone (from PT gland)
->
increased intestinal absorption of calcium
increased kidney reabsorption of calcium
increased calcium reabsorption from bone
111
What findings you see on skull x-ray in hyperparathyroidism?
Pepper pot skull
112
How can primary, secondary and tertiary hyperthyroidism be differentiated in blood tests?
113
How can hyperparathyroidism be managed?
Total parathyroidectomy
Calcimimetics
114
Describe the hormone axis for prolactin
Thyrotropin releasing hormone ->
prolactin ->
stimulates breast tissue, inhibits ovulation
115
How is prolactinoma diagnosed?
serum prolactin & MRI
116
How's prolacinoma managed?
dopamine agonists (cabergoline or bromocriptine)
Tran sphenoidal surgery
117
name the area and what it produces
118
What causes Congenital Adrenal Hyperplasia?
deficiency in the enzyme 21-hydroxylase
119
How can Congenital Adrenal Hyperplasia present in babies?
Baby GIRLS are born with ambiguous genitalia
can have a salt-losing crisis and become very sick within the first few days of life
120
Describe the hormonal axis of cortisol
Corticotrophin Releasing Hormone (CRH)
->
Adrenocorticotrophic hormone (ACTH)
->
Cortisol
121
Describe the difference between Cushing's disease and Cushing's syndrome
Cushing’s syndrome = classic Cushing’s caused by everything but a tumour
Cushing’s disease = Cushing’s caused by a tumour
122
How is Cushing's diagnosed?
24 hour urinary cortisol or a dexamethasone suppression
123
What causes Addisons disease?
Autoimmune destruction of the adrenal cortex causes hyposecretion of all adrenal steroid hormones (aldosterone, glucocorticoids and sex steroids)
124
What is the autoantibody in Addison's?
autoantibodies against 21-Hydroxylase
125
What are the presenting features of Addison's?
Hypotension, hyperkalaemia, hyponatremia
Hyperpigmentation
126
What diagnostic test is used to identify Addison's?
Short synacthen test (ACTH stimulation test)
127
How is an addisonian crisis managed?
100mg IV hydrocortisone
128
What is the chronic treatment of Addison's disease?
Hydrocortisone and fludrocortisone
129
What should people with Addison's do to their medications when they have a short lived illness or are stressed?
double their glucocorticoid dose
130
What should people with Addison's do to their medications when they are seriously ill?
IV Hydrocortisone
131
What is conn's syndrome?
Excessive aldosterone from the zona glomerulosa (of the adrenal cortex) usually due to an adrenal tumour
132
How does conns syndrome present?
hypertension, hyperpigmentation, lethargy
133
How is conns syndrome tested for?
Aldosterone: Renin ratio
134
How is conns syndrome managed?
Surgical resection of adrenal adenoma
135
What is a pheochromocytoma?
neuroendocrine tumour, found in chromaffin cells of adrenal medulla which produces excessive adrenaline
136
How does phaeochromocytoma present?
Hypertension resistant to anti-hypertensives
headaches
sweating
anxiety
137
How is pheochromocytoma diagnosed?
Plasma free metanephrines
138
How is pheochromocytoma managed?
surgical resection of tumour
Alpha blockers
139
What genetic change is associated with pheochromocytoma?
RET
140
What is a normal range calcium?
2.2-2.6 mM
141
What are the two clinical signs of hypocalcaemia?
Trosseau’s sign = The involuntary contraction of the muscles of the hand and wrist that occurs after the compression of the upper arm with a blood pressure cuff
Chovstek’s Sign = The twitching of facial muscles that occurs when gently tapping an individual’s cheek in front of the ear
142
How is calcium regulated?
Parathyroid hormone (increases calcium)
Calcitrol (increases calcium)
Calcitonin (decreases calcium)
143
What causes Ricketts (osteomalacia)?
Vitamin D deficiency
144
Howdoes hypercalcaemia present?
Stones, bones, abdominal moans, psychiatric groans
145
How is hypercalcaemia managed?
Rehydration
IV Bisphosphonates
146
What is SIADH?
Increased release of ADH from posterior pituitary
147
What urine and serum changes does SIADH cause?
high urine osmolality
high urine sodium
low serum sodium
148
What are the 3 most important causes of SIADH?
Post-operative
SSRI
small-cell lung cancer
149
Why do you need to replace sodium slowly in patients with chronic hyponatraemia?
more than a 10mmol/L increase in 24 hours can cause osmotic demyelination syndrome
150
What neoplasms are encompassed by MEN1?
Parathyroid hyperplasia and adenomas
Pancreatic and duodenal endocrine tumours
Pituitary adenoma (prolactinoma)
151
What neoplasms are encompassed by MEN2A?
MEN1 features + parathyroid hyperplasia
152
What gene is involved in MEN2A?
RET
153
What neoplasms are encompassed by MEN2B?
Features of MEN1 & MEN2A + neuromas and skin abnormalities
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