Endocrinology Flashcards
(148 cards)
1
Q
Cushings disease
A
Raised cortisol level specifically due to raised ACTH from a pituitary tumour
2
Q
Cushings syndrome is due to? (2)
A
Excess cortisol
Excess ACTH -> raised cortisol
3
Q
C U S H I N G (mneumonic)
A
Central obesity / Comedones Urinary free cortisol Straiae Hirutuism Immunodeficiency Neoplasms Glucose (raised)
4
Q
Cushings caused by raised cortisol (2)
A
Steroids
Adrenal carcinoma / adenoma
5
Q
Cushings caised by raised ACTH
A
Tumour producing ACTH (not pituitary) e.g. Small cell lung cancer
Cushings disease
6
Q
Cause of pseudocushings
A
alcohol excess
7
Q
Dexamethasone suppression test result meanings
Low dose High dose
Cortisol dec Cortisol dec
No change Cortisol dec
No change No change
A
No pathology - dex suppresses cortisol
Cushings disease - high levels able to suppress excess ACTH
Cushings syndrome - levels of cortisol are high INDEPENDENT of ACTH
8
Q
causes of false +ve dex suppression test
A
obesity
alcoholism
chronic renal failure
9
Q
Screening test for cushings
A
urine cortisol
10
Q
3 complications of cushings
A
cardiac problems
diabetes
osteoporosis
11
Q
Specific clinical presenting feature of cushings disease
A
hyperpigmentation as ACTH activates melanocytes
12
Q
Action of aldosterone
A
Increased sodium and water reabs
Increase K+ secretion
13
Q
Commonest cause of primary aldosteronism
A
Conns syndrome - aldosterone producing adenoma
14
Q
Symptoms of hypokalaemia
A
cramps
abdo pain
muscle weakness
polyuria and polydipsia
15
Q
Signs of hyperaldosteronism
A
fluid overload
hypertension
metabolic acidosis
16
Q
Treatment of primary hyperaldosteronism
A
Aldosterone agonist e.g. spironolactone
Calcium channel blockers
17
Q
Causes of primary aldosteronism
A
Conns syndrome
Adrenal carcinoma
Adrenal hyperplasia
18
Q
Pathophysiology of secondary aldosteronism
A
Increased renin causing increased aldosterone levels
19
Q
Causes of secondary aldosteronism
A
Renal artery stenosis Chronic oedema Cardiac failure Liver failure Hypertension
20
Q
Levels of renin in
1) Primary hyperaldosteronism
2) Secondary hyperaldosteronism
A
LOW
HIGH
21
Q
Treatments of hyperaldosteronism
A
Aldosterone antagonist
22
Q
Pathophysiology of primary hypoadrenalism (addisons)
A
Low levels of all adrenal hormones due to acute adrenal destruction
23
Q
Addisons crisis - patients usually present with one of two conditions
A
Hypoglycaemia
Hypovolaemic shock
24
Q
Most common cause of addisons disease
A
Autoimmune destruction of the adrenal glands
25
Signs and symptoms of low cortisol
Hyperpigmentation
| Hypoglycaemia
26
Signs and symptoms of low aldosterone
Hyponatraemia
Hyperkalaemia
Hypotension - due to fluid and Na+ loss
27
Signs and symptoms of low androgens
Lack of pubic hair in females
Generalised unwell symptoms
28
Addisons crisis features
```
Abdo pain
Vomiting
Hypotension
Tachycardia
Hypovolaemic shock
Collapse
```
29
Important hx to ask if suspect addisions?
steroid use?
30
Key test to help diagnose addisons
synacthen test
31
Short synacthen test result - cortisol not raised
| Long synacthen test result - cortisol not raised
Primary hypoadrenalism
32
Short synacthen test result - cortisol not raised
| Long synacthen test result - cortisol raised
Seconary hypoadrenalism
33
Short synacthen test result - cortisol raised
| Long synacthen test result - cortisol raised
NORMAL
34
SE of steroids
```
B
E
C
L
O
M
E
T
H
A
S
O
N
E
```
```
Buffalo hump
Easy bruising
Cateracts
Large appetite
Obesity
Moon face
Euphoria
Thin arms / legs / skin
Hypertension / hyperglycaemia
Avascular necrosis of femoral head
Skin thinning
Osteoporosis
Negative nitrogen balance
Emotional liability
```
35
Pathophysiology of secondary hypoadrenalism
Dysfuction of hypothalamus, pituitary axis
36
Main causes of secondary hypoadrenalism (2)
Iatrogenic - long term steroid use
Pituitary / hypothalamus tumour / infection / infarction
37
Difference between sign and symptoms of primary and secondary hypodrenalism
Secondary
ACTH low - so no hyperpigmentation
Aldosterone not low so no electrolyte imbalance
38
ACTH levels in
1) Primary hypoadrenalism
2) Secondary hypoadrenalism
HIGH
LOW
39
When should a new drug be added in T2D treatment (HbA1c)
>58
40
T2D diagnosis criteria
If the patient is symptomatic:
fasting glucose greater than or equal to 7.0 mmol/l
random glucose greater than or equal to 11.1 mmol/l (or after 75g oral glucose tolerance test)
If the patient is asymptomatic the above criteria apply but must be demonstrated on two separate occasions.
41
Hyperparathyroidism leads to
Ca2+ levels to...?
PO4 levels to...?
High
Low
42
6 key features of hypercalcaemia
```
Renal stones
Abdominal groans - pain
Polydypsia
Bones (bone pain)
Psychiatric overtones - depression
```
43
Impact of hypercalcaemia on the ECG
shortened QT
44
Most cases of primary hyperparathyroidism are due to?
parathyroid adenoma
45
Primary hyperparathyroidism
Ca2+ results
PTH result
high
high
46
Main therapy in hypercalcaemia
fluid rehydration
47
Secondary hyperparathyroidism
Ca2+ results
PTH results
low
high
48
Two causes of secondary hyperparathyrodism
renal failure
| low vit d
49
tertiary hyperparathyrodism
prolonged secondary so PTH becomes so high, calcium is produced at a v high level. Vit D must be corrected
Increased Ca2+
Vit D normal
PTH high
50
Clinical signs of hypocalcaemia
pins and needles
muscle aches
tetany
chvostek's sign - twitching of facial muscles when the facial nerve is tapped
Arrhythmias
51
Blood tests in hypocalcaemia
```
Ca2+
PTH
Vit D
Phosphate
Magnesium
U&Es
```
52
Most common cause of hypoparathyroidism
iatrogenic - removal during thyroidecomy / post radiation
53
pseudohypoparathyrodism is due to?
resistance to PTH
54
Impaired glucose tolerance
Fasting glucose -
2h post glucose load
6. 0 - 7.0
| 7. 8 - 11.0
55
Presentation of T1D
Age 12
Polydypsia
Polyuria
+/- ketoacidosis
56
Tests in suspected T1D
FBC
Glucose - HbA1C
U&Es
Urine dip - ketone / glucose
57
What other organs should be monitored in diabetes
Eyes
Renal
Vascular
58
Precipitants of diabetic ketoacidosis
Sepsis
Not taking insulin
MI
59
Presentation of ketoacidosis
```
N&V
Confusion
Abdo pain
Lethargy
Tachypnoea
```
60
infusion rate of insulin in ketoacidosis
infuse at a fixed rate of 0.1 units/kg/hour w/ 0.9% NaCl
61
Metformin action
Improves insulin sensitivity
62
Glicalzide action (sulphonylurea)
Stimulates pancreas to secrete insulin
63
Pioglitazone (thiazolidinedones) action
Improves insulin sensitivity
64
Alpha glucose inhibitors
Prevents sugar absorption in the intestine
65
HbA1c target for those managed by diet and lifestyle (+/- drug not causing hypoglycaemia)
48 mmol/mol (6.5%).
66
HbA1c target for people who are taking a drug associated with hypoglycaemia (such as a sulphonylurea)
53 mmol/mol (7.0%)
67
two causes of diabetes insipidus
Cranial e.g. brain tumour / trauma
Nephrogenic e.g. hypercalcaemia, hypokalaemia, CKD
68
diabetes insipidus =
inability of the kidneys to conserve water
69
Symptoms of diabetes insipidus
Polyuria and polydypsia
70
Invesigations in diabetes insipidus
urine / plasma osmolalitty
Water deprivation test - give desmopressin and see response.
71
pathophysiology of DI caused by cranial causes
failure of posterior pituitary to produce vasopressin
72
pathophysiology of DI caused by nephrogenic causes
failure of the kidney to respond to vasopressin
73
Water deprivation test
Cranial cause result ->
Nephrogenic cause result ->
Urine osmolality increases (water retained)
Urine osmolality doesn't change
74
CNS disorders causing SIADH
Tumour
Meningitis
Encephalitis
SAH
75
Pulmonary causes of SIADH
TB
Cancer
COPD
76
Drugs causing SIADH
Diuretics
| Antidepressants
77
Malignancy causing SIADH
Lung
Lymph
Pancrease
78
SIADH creates what type of hyponatramiea
Euvolaemic
79
Symptoms of hyponatraemia
confusion
irrritability
headache
weakness
can get delirum / psychosis / ataxia
80
Hypovolaemia hyponatraemia due to
due to salt loss and water follows
81
Hypervolaemia hyponatraemia due to
excess water
82
Normovolaemic hyponatraemia due to
Na+ loss > water
83
Causes of normovolaemic hyponatraemia
SIADH
| Post op
84
causes of hypervolaemic hyponatraemia
Cardiac failure
Liver failure
Renal failure
Excess intake
85
causes of hypovolaemic hyponatraemia
Extra renal - burns , N&V, dehydration
Renal - diuretic, hypoaldosteronism
86
Bedside investigations in hyponatraemia
UandE
Serum osmolality
Urine osmolality
87
two functions of the testes
produce testosterone
spermatogenesis
88
Presentation of hypogonadism in men
```
decreased libido
erectyle dysfuncton
gynaecomastia
fatigue
delayed puberty
```
89
Main blood test in hypogonadism in med
serum testosterone
90
Main cause of secondary hypogonadism in men
Prolactinoma
91
SE of Sulfonylureas e.g gliclazide
Hypoglycaemic episodes
Increased appetite and weight gain
Syndrome of inappropriate ADH secretion
Liver dysfunction (cholestatic)
92
Glitazones SE
Weight gain
Fluid retention
Liver dysfunction
Fractures
93
Metformin SE
Gastrointestinal side-effects
| Lactic acidosis
94
Causes of primary hyperparathyroidism
single adenoma
diffuse hyperplasia of parathyroid gland
carcinoma
95
Imagining in primary hyperparathyrodism
US
FNA
SESTANIBI - radionuclear scan
96
Treatment of primary hyperparathyrodism
resection
97
Primary hyperparathyrodism blood test results
PTH high
Ca2+ high
Normal vit D
98
Secondary hyperparathyrodism
Something is causing low Ca2+
Kidney - CKD (Vit D not activated)
Low vit D
Osteomalacia
99
Secondary hyperparathyrodism blood test results
PTH high
Ca2+ low
Vit D low
100
Treatment of secondary hyperparathyroidism
alpha calcidol - replace Vit D
101
Treatment of tertiary hyperparathyroidism
Should improve in a year
| or remove
102
Causes for hypercalcaemia
Mets
HyperPara
Myeloid
Sarcoidosis
103
What does the anterior pituitary produce?
```
ACTH
TSH
LH
FSH
GH
Prolactin
```
104
What does the posterior pituitary produce?
ADH and oxytocin
105
Causes of hyperprolactinaemia
Physiological - pregnancy
Drugs - metoclopramide, haloperidol, methyldopa
Neoplasia - prolactinoma
PCOS
106
Presentation of hyperprolactinaemia
amenorrhoea
infertility
galatorrhoea
107
What is myxoedema
infiltraiton of the skin with mucopolysaccharies -> leads to dry waxy skin swelling in those with hypoT
108
Causes of hypothyroidism
```
hashimotos - most common
idiopathic
drug induced e.g. amiodarone, lithium
Iatrogenic
Iodine deficiency
Congenital
```
109
General features of hypothyrodism
```
cold intolerance
letheragy
weight gain
dry skin and hair
low hoarse voice
```
110
Skin changes in HypoT
Dry skin and hair
| loss of outer 1/3 of eyebrow
111
Psychological and neurological aspects of hypoT
Depression
Slow reflexes
Carpal tunnel syndrome
112
CV features of hypoT
Bradycardia
Angina
Non pitting oedema
113
Reproductive features of HypoT
Menorrhagia
| Infertility
114
Thyrotoxic storm
Thyrotoxicosis causes acutely increased metabolism
Life threatening tachycardia
Hypertension
Fever
115
Blood results in
Primary HyperT
Secondary HyperT
High T4 but low TSH
High TSH and T4
116
Causes of primary hyperT
Graves disease
Toxic Multinodular goitre
Toxic adenoma
Over treating of hypothyrodism
117
Cause of secondary HyperT
Pituitary adenoma
118
General features of HyperT
```
Heat intolerance
Weight loss
Diarrhoea
Sweating
Muscle wasting
TREMOR m
```
119
Skin features of HyperT
Dry skin
120
Psychological features of HyperT
Pychosis
Emotional liability
Restlessness
121
Muscular features of HyperT
Myopathy
122
Cardiac features of HyperT
AF
Tachycardia
Palpiations
123
menstrual features of HyperT
Oligomenorrhoea
124
HyperT treatment
Medical
Interventional
Surgical
Carbimazole and Beta blocker
Radioactive iodine
Thyroidectomy
125
Features ONLY found in Graves disease
```
Proptosis
Lid retraction
Preorbital oedema
Diplopia
Limited eye movements
Pretibial myxoedema
Thyroid acropachy
```
126
Specific antibodies to test for in HyperT
Against thyroid peroxidase and thyroglobulin
127
Main cause of benign thyroid cancer
follicular adenoma
128
Types of thyroid carcinoma
medullarly
papillary
follicular
129
Questions to ask about in suspected thyroid cancer
```
Thyroid mass
Usually painless
Dysphagia
Dyspnoea
Hoarseness
Weight loss
B symptoms
```
130
Investigations in suspected thyroid cancer
CXR
US
FNA
Radioisotope
131
Specific test for phaeochromocytoma
24 hr urinary collection of metanephrines (sensitivity 97%*)
this has replaced a 24 hr urinary collection of catecholamines (sensitivity 86%)
132
treatment of thyrotoxic storm
carbimazole
beta blocker
hydrocortisone
133
Which type of lung cancer causes cushing's syndrome
small cell carcinoma
134
paraneoplastic manifestations of squamous cell lung cancer
Parathyroid related protein - hypercalcaemia
135
test to differentiate between T1D and T2D
C- peptide
136
blood pressure targets for diabetics
Diabetes mellitus: hypertension management
NICE recommend the following blood pressure targets for diabetics:
if end-organ damage (e.g. renal disease, retinopathy) < 130/80 mmHg
otherwise < 140/80 mmHg
137
T1D blood glucose targets
In type 1 diabetics, blood glucose targets:
5-7 mmol/l on waking and
4-7 mmol/l before meals at other times of the day
138
2nd line treatment in TD2 who are obese
DPP-4 inhibitors are useful in T2DM patients who are obese
139
only add a second drug in T2D when HbA1c is?
>58 mmol/mol
140
Which patients who take insulin DON'T need to inform the DVLA
Not all patients on insulin have to inform the DVLA. The exceptions are those on temporary treatment for 3 months or less, or gestational diabetes that are taking insulin for less than 3 months post delivery
141
In diabetic foot what has been lost?
loss of protective sensation
142
what ratio can be checked when looking for diabetic nephropathy
albumin: creatine ratio
143
how does hyperglycaemia cause diabetic nephropathy
leads to nephron loss, so RAAS activated and glomerular hypertension -> hyperfiltration of proteins and eventual tubular damage
144
HONK =
| hyperosmoler non-ketotic acidosis
emergency where hyperglycaemia leads to dehydration and hyperosmolality without significant ketoacidosis
145
Bed side tests in HONK
Glucose test
Urine dip and culture
Observations
ECG
146
Further tests in HONK
CXR - likely precipitant is infection
147
Bloods in HONK
```
FBC
U&E
ABG
Glucose
Lactate
Blood cultures
```
148
Treatment
ABCDE
- fluids
- insulin infusion - slower than in DKA
- regular monitoring
- consider LMWH because at risk of clotting
