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Phase 2 - General Medicine > Endocrinology > Flashcards

Endocrinology Flashcards

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1
Q

What is Acromegaly?

A

Excess Growth Hormone due to a pituitary adenoma

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2
Q

What does Acromegaly cause?

Physical Attributes - not on face

A

Spade-like Hands and feet
Sweating
Proximal Myopathy

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3
Q

What does Acromegaly cause?

Conditions

A 
Hypertension
Cardiomegaly and HF
Diabetes (due to poor glucose tolerence)
Visual Field Disturbances (compression)
Fluid retention - Carpal Tunnel, OS Apnoea
Osteoarthritis
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4
Q

How do you investigate Acromegaly?

A 
Glucose Tolerence Test
Insulin Sensitivity
Bloods - glucose, GH, other pit hormones
Bloop Pressure
Urine Dip - glucose
MRI Pituitary Fossa
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5
Q

How do you treat Acromegaly?

A

Transphenoidal Approach
Radiotherapy (if cannot excise)
Medications to lower GH - receptor blocker, somatostatin analogues

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6
Q

What does Acromegaly cause?

Physical Attributes - facial

A

Coarse Features - square jaw, large nose and ears
Frontal Bossing
Wide Spaces between teeth
Macroglossia

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7
Q

What is Cushing’s?

A

Excess cortisol production due to ectopic secretion, an ACTH pituitary adenoma (DISEASE) or a adrenal adenoma
Iatrogenic

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8
Q

What are the physical features of Cushing’s syndrome?

A 
Moon Face
Acne
Buffalo Hump
Abdominal Fat
Purple Striae
Oedema - fluid retention
Bruising
Thin Skin and Hair
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9
Q

What are the disease states related to Cushing’s?

A 
Eyes- Glaucoma, Cataracts
High BP
Easy Bleeding
Steroid Diabetes
Fluid Retention 
GORD
Compressive - Visual Fields, Headaches
Osteoporosis
Immunocompromised
Oligomenorrhoea 
Mood Change
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10
Q

How do you investigate Cushing’s

A

TFTs (hypothyroid)
Early Morning Cortisol

Dexamethosone Suppression - low dose then high (halves Cortisol in DISEASE)

Bloods - glucose, FBC, Clotting (INR), pituitary hormones

MRI Pituitary
24 hour urine Cortisol

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11
Q

How do you treat Cushing’s?

A

Iatrogenic: Stop steroids

Adenoma: Transphenoidal Pituitary Removal or medical treatment if prolactinoma

Bilateral Adrenectomy
Radiotherapy (if adrenal carcinoma)

Treat Cancer (if ectopic) and fluconazole to lower Cortisol

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12
Q

What is Addison’s Disease?

A

Primary Adrenal Failure

Autoimmune destruction of the adrenal cortex, leading to insufficiency

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13
Q

What is Adrenal Failure?

Causes

A

Where adrenals are not able to produce steroids leading to symptoms
Can be due to long-term steroid treatment, sepsis, metastatic cancer, infections (TB)

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14
Q

What are the physical symptoms of Addisons?

A 
Cachexia/Weight Loss
Pigmentation - especially gums, folds of skin
Thin Hair
Thin Nails
Amenorrhoea 
Impotence
Dehydrated
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15
Q

What are the other symptoms of Addisons?

A 
Postural Hypotension
Tiredness, Lethergy
Loss of thirst, appetite
Mood changes - depression
High K+ and low Na+ (loss of aldosterone)
Hypoglycaemia
Weakness
Abdominal Pain and Vomiting
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16
Q

Investigations

A

Short synacthen test
BP - standing and sitting
Bloods - U&Es, cortisol, antibodies, ACTH, glucose, ABGs
Glucose fingerprick test

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17
Q

What is an addisonian crisis?

A

SEVERE Addisons. Usually due to a missed dose or upregulation of dose in illness
Can lead to death due to hypovolaemic shock, heart attack, hypoglycaemia

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18
Q

How do you treat an addisonian crisis?

A 
Steroids IV -hydrocortisone 
Fluids - IV, aggressive
Glucose
Monitor electrolytes - K+ may treating
Treat cause if has one
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19
Q

How do you treat Addisons

A

Hydrocortisone
Fludrocortisone
Emergency Kit
Sick Day Rules, Steroid Card

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20
Q

What is Thyrotoxicosis?

A

Hyperthyroidism

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21
Q

What are the causes of hyperthyroidism?

A 
Autoimmune - Graves disease
Toxic Goitre (old)
Toxic Adenoma
Ectopic Thyroid Tissue (Struma Ovarii, metastatic)
Exogenous
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22
Q

What are the symptoms of hyperthyroidism?

A 
Weight Loss
Gain of Appetite
Not able to sleep
Palpitations
Anxiety/Panic Disorders
Mood Changes
Menstrual changes 
Heat Intolerence
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23
Q

What are the signs of hyperthyroidism?

A 
Tachycardia/Arrhythmias (AF)
Fine Tremor
High BP
Goitre
Exophthalmos, lid lag and retraction
Sweaty
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24
Q

Investigating Thyroid?

Study These Flashcards
A 
TFTs, thyroid antibodies
Cortisol
BP
ECG
Thyroid Examination
Technetium Uptake Scan
USS
25
What is Grave's Disease? Risks?
Autoantibodies IgG bind to the thyrotrophin receptor causing goitre and upregulating hormone production Middle aged, female, pregnancy, stress, other autoimmune conditions
26
Treatment of Hyperthyroidism?
Beta Blockers Carbimazole Radioactive Iodine Thyroidectomy and Levothyroxine
27
Treating a thyrotoxic storm?
``` Severe hyperthyroidism Manage peripheral symptoms (Beta blockers, digoxin may be needed) Treat precipitant (infection etc) Fluids Carbimazole - iodine -surgery ```
28
What is Hypothyroidism?
Where there is insufficient thyroid hormone production
29
What are the normal levels for thyroid hormones?
TSH 0.4 - 4 T4 9 - 25 T3 3.5 - 7.8
30
What is Sick Euthyroidism?
Where the thyroid production is decreased when you are unwell Normally all tests are low
31
What are the causes of Hypothyroidism?
Autimmune - Hashimoto's Trauma Iodine Deficiency (following HyperT treatment) Pituitary Adenoma (secondary) Drug Induced - antithyroid, lithium, amiodarone
32
Who gets hypothyroidism?
``` Also known as myxoedema More common in middle aged females Associated with other autoimmune conditions Down's Syndrome Genetic ```
33
What is Hashimoto's?
Autoimmune lymphocytic infiltration of the thyroid gland, leading to atrophy
34
What are the symptoms of Hypothyroidism?
``` Tiredness and lethergy Mood- depression Weight gain Loss of appetite Heavy periods Cold Intolerence Carpal Tunnel Syndrome Goitre Slow reflexes ```
35
Signs of Hypothyroidism?
``` Weight gain (toad face) Bradycardia Low BP Thin Hair/Skin Cold Periorbital Oedema Low cognition ```
36
What is a toad-like face?
Seen in Hypothyroidism Loss of hair - scalp, 1/3 eyebrows, dull expression, puffy lids, pale
37
How do you treat Hypothyroidism
Levothyroxine (replacement of T4) Can do: Liothyroxine (T3)
38
What is a Pheochromocytoma?
Noradrenaline/Catecholamine releasing medullary tumour of Chromaffin Cells Most unilateral Follow rules of 10: 10% bilateral, 10% malignant, 10% familial, 10% extra-adrenal
39
Investigating a Pheochromocytoma?
24 hour Urine Metadrenaline Test ECG, BP Bloods - TFTs, Cortisol Abdominal CT/MRI
40
Treating a Pheochromocytoma?
``` Alpha Blockers (and Beta Blockers if have heart disease) Adrenalectomy ```
41
Symptoms of a Pheochromocytoma?
The main three: Headache High Heart Rate Sweating ``` Others: Feeling doom/anxiety Weight loss Loss of sleep Heat intolerance Palpitations Horner's syndrome ```
42
Signs of a Pheochromocytoma?
Sweaty BP high Tachycardia
43
What can trigger a Pheochromocytoma?
Compression to area of adrenal glands/Trauma
44
What is hyperaldosteronism?
Raised aldosterone Can be: Primary: Adenoma- Conn's, Hyperplasia Secondary: renal stenosis/hypoperfusion (sepsis etc)
45
What are the signs of hyperaldosteronism?
Fluid retention High Na+, low K+ High BP Polyuria and dipsia
46
Treatment of hyperaldosteronism?
Treat underlying cause: Conn's - removal | Spironolactone pre-op and for adrenal hyperplasia
47
Investigating hyperaldosteronism?
Bloods: U&Es, Renin, Aldosterone BP Urine - glucose
48
What is Diabetes Insipidus?
Insufficient ADH production leading to polyuria (>3L a day) and polydipsia
49
Causes of Diabetes Insipidus?
Nephrogenic: Lithium,CKD, mutation Neurogenic: Pituitary Stalk Compression/Damage to Pit. Hypothalamus - infection, tumour, surgery
50
Investigations of Diabetes Insipidus?
Blood and urine glucose and ketones Serum and urine osmolarity, Na+ (Urine will be hypo-osmolar compared to normal) Blood - U&Es (Na+ high due to attempted fluid retention) Fluid deprivation test for 8 hours to see urine osmolarity: <300 Then give desmopressin to see response
51
Treatment of Diabetes Insipidus?
Desmopressin (ADH analogue) | ADD thiazide and NSAIDs if nephrogenic
52
Diagnosis of Diabetes Insipidus - Osmolarity? | Primary Polydipsia?
<300 | >800
53
What does giving desmopressin do?
if Diabetes Insipidus is nephrogenic then there is no response If it is neurogenic then there is a response
54
Signs of Diabetes Insipidus?
Thirst Polyuria (nocturnal as well) Hypernaturaemia Palpable Bladder
55
What do you do an Insulin Tolerance Test for?
GH and Cushings (ACTH) | Hypoglycaemia normally stimulates the production of these
56
What are some causes of Hypopituitarism?
``` Sheehan's syndrome - post-pregnancy necrosis of the pituitary Trauma Infection Radiation Surgery Adenomas ```
57
What are some signs that it is a pituitary adenoma?
Headaches Changes in other Pituitary hormones Visual field defects (temporal hemianopia)
58
What order are hormones lost in pituitary failure?
``` GH FSH and LH Prolactin TSH ACTH ```
59
How do you treat a prolactinoma?
Dopamine Agonists - Bromocriptine or Cabergoline

Phase 2 - General Medicine (6 decks)

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