Endocrinology Flashcards by Marcus Brookes

Features of addison’s disease

Fatigue, weakness, weight loss, mucocutaneous hyperpigmentation, hypoglycaemia, hypovolaemia, low blood pressure, hyponatraemia and hyperkalaemia

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Features of NF1

2 out of 7:
Six or more café-au-lait spots or hyperpigmented macules greater than 5 mm in diameter in prepubertal children and greater than 15 mm postpubertal

Axillary or inguinal freckles (>2 freckles)

Two or more typical neurofibromas or one plexiform neurofibroma

Optic nerve glioma

Two or more iris hamartomas (Lisch nodules), often identified only through slit-lamp examination by an ophthalmologist

Sphenoid dysplasia or typical long-bone abnormalities such as pseudarthrosis

First-degree relative (eg, mother, father, sister, brother) with NF1

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Common tumours in NF2

Meningiomas, vestibular schwannoma’s (especially bilateral), posterior subcapsular lenticular opacities, neurofibromas

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Which NF is associated with which MEN

NF-1 with MEN-2B

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What is Sheehan’s syndrome?

Pituitary infarct. Happens in child birth due to large blood loss or extremely low BP during or after childbirth. Leads to decreased cortisol but normal aldosterone.

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Order of hormone loss from pituitary due to mass effect

GH, LH, FSH, TSH, ACTH and finally prolactin

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Main cause of t3 toxicosis (normal t4)

Autonomous nodule

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Test for diabetes insipidus

Fluid supression test - urine will fail to concentrate if have DI

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Causes of pseudo-hyponatraemia

Hyperglycaemia, hypertriglyceridaemia and and non-physiological osmolyte - correct these hyponatraemia resolves

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Indicators of SIADH

Hyponatraemia
Urine osmol >100mOsm/kg
Urine Na >20mmol/L
Renal AQP2 excretion

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Signs suggesting against SIADH

Hypotension and hypovolaemia
Non-osmotic AVP release
Oedema
Adrenal Failure

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Management of hypokalaemia

Mild (3-3.4) Sando K 2 tablets TDS
Moderate (2.5-2.9) Sando K 2 tablets QDS
Severe (<2.5) or symptomatic - 40mmol KCL in litre normal saline (max 20mmol/hr). Check Mg and Phos

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Barrter’s syndrome -what is it and what effect on serum electrolytes

TAL Na and Cl transport defect - leads to metabolic alkalosis, low K in blood, high Ca in urine

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Gitelmans’ syndrome - what is it and what effect on serum electrolyte

Thiazide like effect in DCT NaCl transporter - Metabolic alakalosis and hypokalaemia with low Ca in urine

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Effect of cushing’s syndrome on calcium and phosphate levels

Both drop, leading to a secondary hyperpararthyroidism

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Effect of secondary hyperparathyroidism on bone

Increased osteoclast activity and osteoblast dysfunction, causing diffuse osteoporosis, bone pain and pathological fractures

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Initial management of DKA

1L 0.9% NaCl over an hour, then fixed rate insulin (0.1units/kg/hr)

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Other name for Somatomedin C

IGF-1

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What do psammoma bodies on thyroid nodule FNA suggest?

Papillary thyroid cancer (have hypochromatic empty nuclei)

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Which other hormone is raised by medullary thyroid cancer?

Calcitonin

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Which cells are the origin of medullary thyroid cancer?

C-cells

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Effect of Addisonal crisis on U&Es

Hyponatraemia and hyperkalaemia (+hypoglycaemia)

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Deficiency of which 2 molecules can cause familial hypercholesterolaemia?

Apo B-100 deficiency or LDL receptor deficiency

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What is pseudo-hypoparathryoroidism?

Low serum calcium and high phosphate causing PTH to rise

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What is pseudopseudo-hypoparathyroidism?

Albright's heriditary osteodystrophy. Normal lab tests

Effect of secondary adrenal insufficiency on cortisol and aldosterone

Cortisol reduced, aldosterone normal

What percentage of diabetes in the UK is type 1?

10%

Treatment of Graves during first trimester

Propylthiouracil. Avoid carbimazole as teratogenic in first trimester but use after this period

Effect of high dose Dex suppression on Cushing's disease

Reduction in Cortisol

HbA1c for pre diabetes

Between 42-47

Effect of congenital adrenal hyperplasia on adrenal hormones

Decrease gluco and mineralocorticoids with increased sex steroids

Effect of congenital adrenal hyperplasia on adrenal hormones

Decrease gluco and mineralocorticoids with increased sex steroids (causing penile enlargement in boys and ambiguous sex in girls)

Consequences of thyrotoxic storm if left untreated

Acute congestive HF, shock and death

Main cause of secondary hyperparathyroidism

Chronic renal failure

Blood results in primary hyperparathyroidism

Raised Ca, Raised vit D, raised (or inappropriately normal) PTH and decreased phos

Blood results in secondary hyperparathyroidism

Decreased or normal Ca, decreased Vit D, increased PTH and Inc or dec phos

Blood results in tertiary hyperparathyroidism

High Ca, low vit D, very high PTH and increased phos

What is De Quervain's thyroiditis?

A subacute, granulomatous thyroiditis. Can cause hyperthyroidism initially progressing to hypothyroidism with destrcution of the thyroid gland. Can finally resolve or persist

Effect of insulin on protein synthesis

Increases protein synthesis in the muscles

Effect of primary hyperparathyroidism on acid-base balance

Mild hyperchloraemic metabolic acidosis

What are Brown tumours?

Cystic lesions in the bone formed of osteoclasts occuring in primary hyperparathyroidism - can result in pathological fractures

Clinical signs of primary hyperparathyroidism

Arcus senilis, reddened conjunctiva due to Ca2+ spilling out (usually lateral and medial effected rather than sup. and inf.). Often have erosion of the terminal phalynx on x-ray as well if long standing

Dietary advice for those with primary hyper parathyroidism

Don't avoid Ca containing foods as this can make it worse

Which class of tumours are most strongly related with humoral hypercalcemia of malignancy?

Squamous cell carcinomas (multiple organs of origin)

What is the mechanism of humoral hypercalcaemia of malignancy?

Release of PTHrP by tumour cells - acts like PTH in the tissues.

Effect of myeloma on Ca2+ and phos levels

Both can be raised - phosphate raised due to effect of all the Ig secreted by plasma cells on the kidney

Specific treatment of hypercalcaemia in myeloma

Steroids - high doses

ECG sign of hypocalcaemia

Prolonged QTc interval

Most common cause of hypoparathyroidism

Post-surgical (

Mechanism of Albright's hereditary osteodystrophy

Tissue resistance to PTH (+/- other hormone resistances). Also known as pseudohypoparathyroidism

Which electrolyte must be corrected in order to correct calcium

Magnesium - hypocalcaemia can't be corrected if hypomagnesaemia

Difference between osteoporosis and osteomalacia

Osteoporosis is normal bone but less of it whereas osteomalacia is decreased concentration of mineral in bone

Difference between pseudohypoparathyroidism and pseudopseudohypoparathyroidism

Both caused by GNAS genes and have same phenotypic appearance but normal lab tests (inc PTH and Ca)

Cause of tertiary hyperparathyroidism

Uncorrected secondary hyperparathyroidism - high Ca. Usually raised phos and low vit D as main cause is Vit D deficiency.

Second line medication in type 2 diabetes for patients with high BMI

DPP-4 inhibitors

When does subacute lymphocytic thyroiditis usually occur?

After pregancy - also known as postpartum thyroiditis. Can present with thyrotoxicosis progressing to hypothyroid

Fasting glucose cut off for diagnosis of T2DM

7mmol/L

2 hour glucose level after 75g glucose cut off for T2DM

11.1mmol/L (also applies for a random sample in patient with classical symptoms of diabetes)

HbA1c cut off for T2DM diagnosis

48 or more

Management of hyponatraemia in SIADH

Fluid restricition - 800ml in 24 hours | Avoid giving fluids as makes worse - all of Na excreted but some of the water retained

Target increase in serum Na in profound hyponatraemia

5-8mmol/L per day

Inheritance pattern of MEN1

Autosomal dominant

Anaplastic thyroid cancer histological appearance

Large pleomorphic giant cells

What type of receptor and pathway does GH act on?

Tyrosine kinase receptor on JAK/STAT pathway

What is reifenstein syndrome?

Male. Partial androgen insensitivity. Present with enlarged breasts and erectile dysfunction

Treatment for MODY

Glucokinase - none HNF-1a and 4a - low dose sulphonureas HNF-1b - insulin

Clinical features of MODY

Residual insulin secretion 3 years after diagnosis of type 1 diabetes Young age of onset Lack of metabolic syndrome in those with presumed type 2 DM

2 main classes of MODY

Glucokinase and transcription factor

Which MODY is associated with renal cysts/failure?

HNF-1b

Classic triad of Graves disease

Pretibial myxoedema Thyroid opthalmology Thyroid acropatchy

Endocrinology Flashcards

(70 cards)