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Endocrinology Flashcards

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1
Q

What is goitre?

A

Any swelling of the thyroid gland

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2
Q

Name 4 possible causes of diffuse smooth goitre.

A

Physiological (increased demands for thyroid hormone, e.g. pregnancy)
Grave’s disease
Thyroiditis
Dietary iodine deficiency

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3
Q

What general findings would you find in hyperthyroidism?

A 
Warm, moist skin
Fine hair/alopecia
Peripheral oedema
Onchylosis
Thyroid acropachy
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4
Q

What two drugs can cause hyperthyroidism?

A

Iodine

Amiodarone

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5
Q

In what thyroid condition would you see gynaecomastia?

A

Hyperthyroidism

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6
Q

What is hyperthyroidism?

A

Condition caused by increased levels of circulating thyroxine (T4) and/or tri-iodothyronine (T3)

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7
Q

In which gender is thyroid disease more common?

A

Female

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8
Q

How would you investigate hyperthyroidism?

A 
TSH
Free T3 and T4
FBC
Liver enzymes
ESR
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9
Q

What drugs would be used to treat hyperthyroidism?

A

Beta-blockers for symptom control

Carbimazole or propylthiouracil +/- additional T4 (block and replace method)

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10
Q

What surgery would you consider to treat hyperthyroidism?

A

Thyroidectomy

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11
Q

Why are hyperthyroid patients encouraged to stop smoking?

A

Smoking is main risk factor for thyroid eye disease

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12
Q

What is Grave’s disease?

A

An autoimmune disorder of the thyroid gland

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13
Q

What drugs can cause hypothyroidism?

A

Lithium

Amiodarone

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14
Q

What is the difference between T4 and T3?

A

T4 is the pro hormone and is converted to T3 in peripheral tissues, where T3 then has an action

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15
Q

What is TRH and where is it secreted?

A

Thyrotropin-releasing hormone

Secreted by hypothalamus

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16
Q

What is TSH and what produces it?

A

Thyroid-stimulating hormone

Produced by thyrotrophs of pituitary gland

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17
Q

What does TSH do?

A

Increases serum levels of T3 and T4

Promotes conversion of T4 to T3

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18
Q

What are the effects of thyroid hormones of CVS?

A

Increased heart rate

Increased cardiac output

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19
Q

What are the effects of thyroid hormones on skeletal system?

A

Increased bone turnover and resorption

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20
Q

In general, what do thyroid hormones do to the body?

A

Increase basal metabolic rate

Increase rate of oxygen consumption under basal conditions

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21
Q

What produces calcitonin?

A

Parafollicular (or C) cells in thyroid gland

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22
Q

What is the effect of calcitonin?

A

Decrease the level of calcium in the blood by inhibiting action of osteoclasts

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23
Q

What is hypothyroidism?

A

Underactivity of the thyroid gland

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24
Q

Where is the common cause of hypothyroidism?

A

Primary (from the thyroid gland)

not higher up the axis, i.e. secondary

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25
Name symptoms of hypothyroidism.
``` Tiredness/malaise Weight gain Cold intolerance Goitre Bradycardia Slow-relaxing reflexes ```
26
How would you investigate hypothyroidism?
Serum TSH Free T3 and T4 FBC Lipids
27
What would you expect to see on a blood test of someone with primary hypothyroidism?
High TSH | Low T4
28
How would you treat hypothyroidism and for how long?
Levothyroxine (synthetic thyroxine) | For life
29
What is the most common cause of hyperthyroidism?
Grave's disease
30
What are the four categories of hormones?
Peptide and proteins Amino acid derivatives Steroids Fatty acid derivatives (eicosanoids)
31
By which process are protein preprohormones modified in the ER?
Glycosylation
32
What are steroid hormones derived from?
Cholesterol
33
Where are steroid hormones synthesised?
Adrenals Gonads Placenta
34
Name the hormones produced and secreted by the anterior pituitary.
``` LH and FSH Growth hormone Prolactin TSH ACTH ```
35
What does the posterior pituitary gland do?
Stores (but does not produce) vasopressin (ADH) and oxytocin
36
What is the most common cause of pituitary disease?
Pituitary tumour
37
What is Cushing's syndrome?
Describes the signs and symptoms associated with prolonged exposure to inappropriately high levels of cortisol
38
What is Cushing's disease?
Increase secretion of ACTH from the anterior pituitary
39
What is the most common cause of Cushing's disease?
Pituitary adenoma
40
How would you investigate a suspected pituitary tumour?
MRI of the pituitary | Visual fields
41
What are the three major conditions usually caused by secretions from pituitary adenomas?
Hyperprolactinaemia (prolactine excess) Acromegaly/gigantism (GH excess) Cushing's disease (excess ACTH secretion)
42
Name some causes of hypopituitarism.
Congenital (eg Kallmann's syndrome) Infection (eg basal meningitis) Vascular (eg carotid artery aneurysm) Neoplastic (eg pituitary tumour)
43
What stimulates release of ACTH?
Corticotropin-releasing hormone from the hypothalamus
44
What does ACTH do?
Stimulates cortisol production and secretion from zone fasciculata of the adrenal cortex
45
What is the predominant mineralocorticoid produced in humans and where is it produced?
Aldosterone from the zone glomerulosa in the adrenal cortex
46
What does carbimazole do?
Inhibit formation of thyroid hormones | Is also an immunosuppressive agent
47
What is thyroid crisis or 'thyroid storm'?
``` Rapid deterioration of hyperthyroidism with: Hyperpyrexia Severe tachycardia Extreme restlessness Cardiac failure Liver dysfunction ```
48
In the foetus what do the testis produce to promote sexual differentiation and what does it do?
Anti-Mullerian hormone | Causes atrophy of the Mullerian ducts
49
What do pulses of GnRH released from the hypothalamus cause secretion of?
LH and FSH from the pituitary
50
What does LH do in male?
Stimulate production of testosterone from Leydig cells of testis
51
What does FSH do in the male?
Stimulate Sertoli cells in seminiferous tubules to produce mature sperm and inhibins A and B
52
What does LH do in the female?
Stimulate ovarian androgen production by ovarian theca cells
53
What does FSH do in the female?
Stimulate follicular development and aromatase activity | Stimulate release of inhibin from ovarian stromal cells
54
In early puberty which gonadotropin begins to rise first?
FSH
55
What is precocious puberty?
Development of secondary sexual characteristics, or menarche in girls, at or before age of 9
56
How would you investigate precocious puberty?
``` LHRH/LH FSH test MRI pituitary oestradiol ovarian ultrasound Free T4 Bone age scan ```
57
What is Kallmann's syndrome?
Isolated GnRH deficiency | usually X-linked
58
What is Addison's disease?
Primary hypoadrenalism, caused by destruction of entire adrenal cortex
59
How are cortisol levels affected in Addison's? | And how does this affect levels of CRH and ACTH?
Reduced cortisol, leads to increased CRH and ACTH
60
What causes hyper pigmentation in Addison's?
Increased levels of CRH and ACTH
61
How do you treat Addison's disease?
Long-term glucocorticoid and minerlaocorticoid replacement
62
What are the clinical features of Addison's?
``` Hyperpigmentation Postural hypotension Weight loss Depression Malaise ```
63
What can cause secondary hypoadrenalism?
Hypothalamic-pituitary disease (inadequate ACTH production) | Long-term steroid therapy
64
What are the clinical features of Cushing's syndrome?
``` Plethora Bruising Hypertension Weight gain Pathological fractures Striae (purple or red) Proximal myopathy ```
65
How would you confirm diagnosis of Cushing's syndrome?
``` 48-hour low dose dexamethasone test 24-hour urinary free cortisol measurements Circadian rhythm (cortisol blood tests) ```
66
What tests would you use to determine the cause Cushing's syndrome?
``` Adrenal CT/MRI Pituitary MRI Plasma potassium levels High-dose dexamethasone test Plasma ACTH levels CRH test Chest X-ray ```
67
What causes congenital adrenal hyperplasia?
Autosomal recessive deficiency of enzyme in cortisol synthetic pathway Most commonly 21-hydroxylase deficiency
68
How can severe CAH present at birth?
With sexual ambiguity or adrenal failure
69
How is cortisol affected in CAH and what does this cause?
Cortisol is reduced | Feedback leads to increased ACTH secretion
70
What is hyperaldosteronism?
Disorder of the adrenal cortex characterised by excess aldosterone production
71
What are the clinical features of hyperaldosteronism?
Sodium retention and potassium loss, causing hypokalaemia and hypertension
72
What are the main causes of primary hyperaldosteronism?
Bilateral adrenal hyperplasia (normally idiopathic) | Adrenal adenoma
73
What occurs in secondary hyperaldosteronism?
Excess renin stimulation of zone glomerulosa
74
How is bilateral adrenal hyperplasia treated?
Spironolactone (aldosterone antagonist)
75
What are phaechromocytomas and paragangliomas?
Rare tumours of the sympathetic NS that secrete catecholamines
76
How is the secretion of PTH controlled?
Plasma calcium levels
77
What is the effect of PTH?
Increase in serum calcium: Increase osteoclast activity Stimulate uptake of calcium in GIT Enhance urinary excretion of phosphate
78
What causes high levels of calcitonin to be released?
Rise in serum calcium
79
What are the most common causes of hypercalcaemia?
Primary hyperparathyroidism | Malignancies
80
What are the causes of primary hyperparathyroidism?
Single parathyroid adenoma | Diffuse hyperplasia of all parathyroid glands
81
What is the cause of secondary hyperparathyroidism?
Physiological compensatory hypertrophy of parathyroid glands, due to hypocalcaemia caused by chronic kidney disease or vitamin D deficiency
82
Name some symptoms of severe hypercalcaemia.
``` Tiredness/malaise Dehydration Depression Renal colic (from stones) Hypertension Haematuria Bone pain Abdo pain ```
83
How would you investigate hyperparathyroidism?
``` Fasting serum calcium and phosphate Serum PTH Renal function 24-hour urinary calcium Abdominal X-rays Imaging for tumour (eg MRI) ```
84
How is primary hyperparathyroidism medically managed?
High fluid intake Low calcium and vitamin D intake Exercise encouraged
85
When is surgery indicated for primary hyperparathyroidism?
``` Renal stones/impaired renal function Bone involvement Marked hypercalcaemia Young patient (i.e. <50) Previous episode of severe acute hypercalcaemia ```
86
What are the main causes of hypocalcaemia?
Chronic kidney disease Severe vitamin D deficiency Post-thyroid or parathyroid surgery Idiopathic hypoparathyroidism
87
How does hypoparathyroidism normally present?
Neuromuscular irritability | Neuropsychiatric manifestations
88
How is hypoparathyroidism normally diagnosed?
History Clinical picture Low serum calcium Absent/low PTH levels
89
What is Conn's syndrome?
Primary hyperaldosteronism

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