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Phase 2a Summaries > Endocrinology > Flashcards

Endocrinology Flashcards

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1
Q

What is the name of the dopamine agonist used in acromegaly and prolactinoma?

A

Cabergoline

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2
Q

What is the pathophysiology of acromegaly?

A

Increased secretions of GH from pituitary tumour or hyperplasia. GH stimulates soft tissue growth through increased secretion of insulin like growth factor 1.

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3
Q

What two hormones does the posterior pituitary secrete?

A

Vasopressin (supraoptic nucleus) and Oxytocin (paraventricular nucleus)

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4
Q

What is the action of oxytocin?

A

Smooth muscle contraction in uterus, and lactation in the breast

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5
Q

What is the action of vasopressin?

A

ADH - acting on collecting ducts - reabsorption of water so decrease urine output
Also causes arteriolar constriction which leads to peripheral vascular resistance and increase BP

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6
Q

Name 5 hormones secreted in hypothalamus that cause secretions in anterior pituitary?

A 
Thyrotropin releasing hormone (TRH) 
Corticotropin releasing hormone (CRH) 
Gonadotropin releasing hormone (GnRH) 
Growth hormone releasing hormone (GHRH) 
Dopamine
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7
Q

Which 6 hormones are secreted in the anterior pituitary?

A
  1. FSH
  2. LH
  3. GH
  4. Prolactin
  5. ACTH
  6. TSH
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8
Q

What is the action of prolactin?

A

Stimulates lactation in the breasts

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9
Q

Which hormone from hypothalamus stimulates prolactin release and which hormone inhibits it?

A

TRH - stimulates prolactin release

Dopamine- inhibits it (overrides TRH)

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10
Q

What negative feedback loop is caused by increased prolactin?

A

Causes decreased of GnRH release from hypothalamus

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11
Q

Which nucleus in the hypothalamus controls the circadian rhythm?

A

Suprachiasmatic nucleus

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12
Q

Name the two most common causes of primary adrenal insufficiency?

A

Addisons disease and CAH (congenital adrenal hyperplasia)

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13
Q

Name 5 signs and symptoms of adrenal crisis?

A

Hypotension, hypoglycaemia, hyponatraemia and hyperkalaemia, fatigue and fever

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14
Q

Why do you get hypoglycaemia, hyponatraemia, hyperkaelamia in adrenal crisis?

A

Lack of production of aldosterone, causes hyponatraemia and hypoerkalemia because aldosterone is not reabsorbing Na in kidneys, hypoglycaemia because cortisol isn’t producing

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15
Q

What is the immediate management of adrenal crisis?

A

Hydrocortisone

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16
Q

In acromegaly why is GH plasma levels non-diagnostic?

A

GH is pulsatile- increases in stress, sleep, pregnancy and puberty

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17
Q

What are the 3 stages of diagnosis in acromegaly?

A
  1. Plasma GH levels
  2. Glucose tolerance test (should be no suppression of glucose)
  3. IGF-1 levels
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18
Q

Give 4 signs of acromegaly?

A

Acral enlargement, maxiofacial changes, scalp folds, curly hair

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19
Q

What are the 3 stages of treatment for acromegaly?

A
  1. Transphenoidal surgery
  2. Medical therapy
  3. Radiotherapy
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20
Q

Give two disadvantages to using radiotherapy in acromegaly?

A

Delayed response

Can cause hypogondism

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21
Q

Which are the 3 medications used in acromegaly treatment in order of effectiveness?

A
  1. Somatostatin analogue - eg IM octreoride
  2. GH receptor antagonist eg Pegvisomant
  3. Dopamine antagonist eg oral cabergolin
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22
Q

Give 4 symptoms of acromegaly?

A

Amenorrhoea, loss of libido, headache, sweating, snoring, skin darkening, weight gain and low voice

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23
Q

Give 3 causes hyperprolactinaemia?

A
  1. Prolcatinoma
  2. Compression of pituitary stalk –> decreased dopamine
  3. Drugs eg dopamine antagonists
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24
Q

What medication would you use to treat prolcatinoma?

A

Dopamine agonist eg Oral Cabergoline

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25
Give 3 common presentations of prolactinomas?
1. Amenorrhoea 2. Infertility 3. Decreased libido and increased weight
26
What 3 signs would you expect to see in Conn's syndrome?
Hypernatraemia, hypokalaemia and hypertension
27
What would you see on an ECG in a patient with Conns?
Hypokalaemia = flat T waves, ST depression and long QT
28
What is a) initial screening and b) diagnostic investigation in Conns?
a) Plasma aldosterone: renin ratio | b) aldosterone antagonist ef oral spironalactone
29
Name 2 treatment methods for Conns?
1. Laproscopic aldrenalectomy | 2. Oral spironolactone
30
How do you diagnosis secondary adrenal insufficiency?
Low ACTH and normal mineralocorticoid
31
What is the pathophysiology behind secondary adrenal insufficiency?
Lack of ACTH due to problems with the HPA axis - most common cause is iatrogenic
32
What are the two causes of primary adrenal insufficiency?
1. CAH - congenital adrenal hyperplasia | 2. Addisons
33
Give 3 causes of Addisons disease?
Adrenalitis, infections eg TB, adrenal infarction, metastases from lungs and stomach
34
Name 3 symptoms you can get due to cortisol deficiency in addison's?
Fatigue, muscle weakness, hyper pigmentation, abdominal pain
35
Name a symptom you can get due to a) aldosterone deficiency and b) androgen deficiency in addison's?
a) Postural hypotension | b) Loss of libido and menstrual irregularities
36
Name 4 things you would see on a blood test for a patient with Addisons?
1. Hypnatraemia, hyperkalaemia, hypoaldoesteronism, eosinophils and anaemia
37
Which adrenal antibody may be present in Addison's disease?
21 hydoxylase antibody
38
Name 2 diagnostic tests you would perform in addison's?
1. Short ACTH stimulation test using tetracosaride | 2. 9am ACTH levels
39
Give 2 treatment methods for addison's disease?
1. Replace cortisol with hydrocortisone | 2. Replace mineralcorticoaids with fludrocortisone
40
What is diabetes insidipidus?
Passage of large volumes of dilute urine due to impaired water reabsorption in kidney - passage of urine >3L
41
Give 3 cranial causes of diabetes insipidus?
Idiopathic, congenital defect in ADH gene, tumour eg posterior pituitary and trauma
42
Give 3 nephrogenic (resistant to ADH) causes of diabetes insipidus?
Metabolic (hypercalacermia, hypokalaemia) Drugs (Lithium) Osmotic diuresis (diabetes mellitus) Inherited
43
What is the clinical presentation of diabetes insipidus?
Polyuria, compensatory polydipsia, hypernatraemia (lethargy, weakness), dehydration
44
How do you differentiate cranial and nephrogenic causes of DI?
Water deprivation test then | Desmopressin stimulation - urine not concentrated in nephrogenic
45
Give a treatment method for a) nephrogenic and b) cranial causes of diabetes insidipidus?
a) Thiazide diuretics eg oral bendrofluromethiazide | b) Give oral desmopressin
46
What should the normal blood glucose be between?
3.5-8mmol/L
47
Give 4 causes of secondary Diabetes?
a) Pancreatic pathology eg Haemochromatosis 2. Endocrine disease eg acromegaly 3. Drug induced eg thiazide diuretics 4. Maturity onset diabetes of youth (MODY)
48
Which tissue type is type 1 diabetes associated with?
HLA DR3 and HLA DR4
49
Which other autoimmune diseases are associated with type 1 diabetes?
Autoimmune thyroiditis, coeliac disease, addison's disease, perncious anaemia
50
Name 5 of the presenting features of type 1 diabetes?
1. Polyuria 2. Polydipsia 3. Muscle and weight loss 4. Blurred vision 5. Pruritus valence and balantis 6. Hunger due to decrease useable energy source
51
Which 3 factors would lead to an immediate diagnosis of type 1 diabetes if 2/3 were present?
Weight loss, short history of severe symptoms and moderate/large urinary ketones
52
What are the 3 main types of insulin given in type 1?
1. Short acting soluble insulin 2. Short acing insulin analogue 3. Long acting insulin
53
Give 4 complications of insulin treatment?
1. Hypoglycaemia 2. Injection site - lipohypertrophy 3. Insulin resistance 4. Weight gain
54
Give 3 biochemical factors you need to make a DKA diagnosis?
1. Hyperglycaemia >11mmol/l 2. Raised plasma Ketones (>2 on urinary dipstick) 3. Metabolic Acidosis, plasma Hco3 <15mmol
55
Give 4 complications of DKA?
Hypotension Cerebral oedema Adult Respiratory Distress syndrome Arrhythmia (if K+ unmanaged)
56
Give 3 signs of DKA?
Hyperventilation (Kussmal breathing) , hypotension, tacycardia, ketonic breath, coma
57
Give 3 symptoms of DKA?
Polyuria, polydipsia, cause, vomitting, drowsiness, confusion
58
Give 4 symptoms of hypoglycaemia?
Sweating, tremor, drippiness, confusion, sweating, hungry, personality change
59
What does EXPLAIN stand for in non-diabetic causes of hypoglycaemia?
Exogenous drugs, pituitary insuffieicny, liver failure, addison's, islet cell tumour,non-pancreatic neoplasm
60
Name 4 factors for diabetes diagnosis?
1. Random plasma glucose >11mmol/L 2. Fasting plasma glucose >7mmol/l 3. Oral glucose tolerance test] a) fasting >7mmol b) after 2 hours >11 mol 4. HbA1c >6,5% normal
61
Give 3 risk factors of type 2 diabetes?
1. Overweight/obese 2. Family history 3. Hypertension, increased triglycerides/cholesterol 4. South Asia
62
What is the first line treatment of T2 diabetes?
Lifestyle changes: Dietary factors, weight loss and exercise, ACE inhibitors and statins
63
Which 3 medications are used to treat diabetes mellitus?
1. Metformin - increase insulin sensitivity and reduce rate of gluconeogenesis in liver 2. Sulfonyura (gliceride) - increases insulin 3.
64
Name 5 complications associated with poor glycemic control?
1. Diabetic neuropathy 2. Diabetic nephropathy 3. Peripheral vascular disease 4. Diabetic retionopathy 5. Stroke / MI
65
What is the function of the parathyroid?
Releases PTH in response to decreased calcium levels - increases calcium reabsorption in kidneys and decreases calcium excretion - stimulates hydrolysis of 25-hydroxyvitamin D to caclitriol
66
Give 5 symptoms/ signs of hypercalcaemia as a result of primary hyperparathyroidism?
Renal stones. painful bones, abdominal groans (Gi upset, nausea) psychiatric moans (lethargy, fatigue and memory loss)
67
What would the lab results show in primary hyperparathyroidism?
Increase PTH, Increase Ca, decrease phosphate,
68
What would the lab results show in primary hyperparathyroidism?
Increase PTH, Decrease Ca, increase phosphate, increase alkaline phosphate
69
What are the causes of secondary hyperparathyroidism?
Chronic kidney disease and vitamin D deficiency
70
Which lab result excludes hyperparathryoidism (primary, secondary and tertiary)?
Low PTH
71
Which 4 tumours can cause hypercalcaemia of malignancy ?
Squamous cell lung tumour, renal and breast (secrete parathryoid like protein) Bone infiltration due to multiple myeloma and secondary metastatses Lymphoma
72
What would the lab results show in hypercalcaemia of malignancy?
Low PTH as tumour produces parathyroid like protein, high calcium, low albumin
73
In acute severe hypercalcaemia what would be your management steps?
Saline - increase fluid Bisphosphonates Steroids eg prednisolone
74
Why is the phosphate high in primary hypoparathyroidism?
Phosphate reabsorption from the kidney is reduced by PTH. Thus if PTH levels are low, serum phosphate will rise (more will be reabsorbed).
75
What is the most common cause of hypocalcaemia and what is the mechanism behind this?
Secondary to increased phosphate levels in CKD. Decrease calcitriol production and phosphate rentention
76
Give 3 causes of vitamin D deficiency?
Reduced UV exposure, Malabsorption Anti-epilieptic drugs
77
How do you treat acute hypocalcaemia?
IV calcium gluconate
78
How do you treat vitamin D deficiency?
Oral colecalciferol
79
How do you treat hypoparathyroidism?
Calcium supplements + calcitriol
80
Name 2 signs you would see in hypocalcaemia?
Trousseau's sign- carpopedal spasm (hand spasm) | Chvostek's sign - twitching of ipsilateral facial muscles on facial nerve
81
What is the clinical presentation of hypocalcaemia?
SPASMODIC (Spasms, personal parasthesia, anxious, seizures muscle tone increase, orientation impaired, dermatitis, impetigo hepetiformis, Choveks sign
82
What would the lab results be in hypoparathyroidism?
Low serum calcium, low PTH, high phosphate
83
Name 4 investigations you could perform in hypercalcaemia?
``` X-Ray eg pepper pot skull DXA bone density scan High resolution CT Radioisotope scanning Parathyroid ultrasound ```
84
What is the definition of osmolality?
The concentration of a solution expressed as the total number of solute particles per kilogram
85
What is the definition of hyponatraemia?
Serum sodium <135mmol/L | Severe <125mmol/l
86
Give the 4 main causes of hyponatraemia?
SIADH, blood sample from drip arm, renal failure, malignancy, iatrogenic
87
Give 4 symptoms of hyponatraemia? (quicker the onset the worse the symptoms)
Headache, lethargy, anorexia and abdominal pain, weakness, confusion, agitation, coma (severe cases)
88
Name 3 drugs which causes SIADH?
Carbamazepine, thiazides, MAO inhibitors
89
What is the clinical presentation of hyperkalaemia?
Fast, irregular rapid pulse, chest pain, weakness, muscle pain, fatigue, kaussmaul respiration if metabolic acidosis
90
Give the 2 main causes of hyperkalaemia?
AKI Drugs eg Spironalactone, ACE, NSAIDS (accosted with Addisons)
91
Name 3 characteristics of an ECG in a patient with hyperkalaemia?
Tall tented T waves, small P waves and a wide QRS
92
Name 3 characteristics of an ECG in a patient with hypokalaemia?
Small inverted T waves, prominent U waves, long PR interval and depressed ST segments
93
Give a cause of a false hypocalcaemia?
Low serum albumin
94
If serum calcium is low, what changes to QT interval?
It gets longer
95
Give 3 causes of hypocalcaemia?
Vitamin D deficiency leading to osteomalacia
96
Give 4 causes of hypoparathyroidism?
Syndromes, genetic, surgical, radiation, autoimmune, infiltration, magnesium deficiency
97
What is pseudohypoparathyroidism?
Resistance to parathyroid hormone
98
What hand abnormality would you see in pseudohypoparathyroidism?
short fourth metacarpal
99
What are the two most common causes of hypercalcaemia?
Malignancy | Primary hyperparathyroidism
100
How does lymphoma cause hypercalcaemia?
Lymphoma has macrophages, macrophages express 1 alpa hydroxyylase which converts 25-hydroxyvitamin D to 1,25 hydroxyvtaiman D
101
What is the major a) extracellular and b) intracellular cation?
``` Extracellular = Sodium Intracellular = Potassium ```
102
How is osmolality measured?
Measured by an osmometer by freezing point
103
Name two methods to diagnose diabetes insidious?
Water deprivation test | Hypertonic saline infusion and measurement of AVP (vasopressin)
104
Name 3 tests you would do in a patient with hyponatraemia?
1. Plasma osmolality 2. Urine osmolality 3. Plasma glucose 4. Urine sodium
105
What is a craniophayngioma?
Squamous epithelial remnants of Rathke's pouch
106
What do patients with meningioma usually present with?
Loss of visual acuity | Endocrine dysfunction and visual field defects
107
Give 4 consequences of large masses in the pituitary?
1. Visual field defects 2. CSF rhinorrhoea 3. Headaches 4. Cranial nerve palsy
108
What is first line imaging in pituitary dysfunction?
MRI
109
Why does a patient need a long acting insulin?
Gluconeogenesis, glycogenloysis
110
What are the non-pharmacological management of diabetes?
Education - self - management DAFNE - type 2 diabetes Exercise - HbA1c <48
111
In pregnancy what are risks for someone with type 1 diabetes?
Pre-eclampsia, miscarriage
112
What level is hypoglycaemia?
<3mmol, symptoms <4mmol
113
What are the symptoms of hyperthyroid?
Tachycardia, sweating, palpitations, hungry, weight loss
114
What is the main causesof hyperthyroid?
Graves disease (40-60%) Toxic multi nodular goitre Toxic adenoma - bright red hot spot
115
What are triggers of hyperthyroid?
Addisons, Type 1 DM, Pregnancy, Stress, Infection
116
What is one of the methods in administrating carbimazole?
Block and replace (higher dose carbimzaole) and T4
117
What are the functions of PTH?
Increase calcium reabsorption in kidney, increase osteoclast activity (increase calcium), activate vitamin D
118
What is the difference between gigantism and acromegaly?
Gigagantism when your growth plates haven't fused
119
What is the role of Incretins?
Released after eating , increase pancreatic B cells to produce insulin to decrease blood glucose and promote satiety
120
Which patients are most at risk of diabetic retinopathy?
Long term diabetes, insulin treatment, poor glycemic control and pregnancy
121
In diabetic retinopathy what would you see on fundoscopy?
Cotton wool spots, haemorrhage, microanuerisms, macular thickening
122
Give 4 signs of vascular disease in a patient with diabetes?
Diminished pedal pulse, cold feet, weak skin and nails, absence of hair on legs
123
Give two educational programmes provided for patients with type 2 diabetes?
Desmond, DAFNE
124
Give 5 components of the diabetic review?
Take BP, review blood glucose control, review HbA1c and cholesterol levels, advise change in regimen, eye and foot examination, take height and weight
125
What are the triggers for diabetic ketoacidosis?
Infection, surgery, MI, pancreatitis, chemotherapy, antipsychotics, non-compliance
126
Give some treatments you would use in diabetic ketoacidosis?
Saline bolus (if BP low), IV rapid acting insulin, K+ replacement
127
What are you worries about in a patient with hyperglycaemia?
DVT - give prophylaxis
128
What is Phaeochromoctoma?
Catecholamine producing tumour arising from chromatin cells - usually found in adrenal medulla
129
What is the triad of presentation in Phaeochromoctoma?
Episodic headache, sweating, tacycardia - hypertension

Phase 2a Summaries (12 decks)

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