Endocrinology Flashcards

Question

What are the symptoms of SIADH?

Answer 1

Stupor/coma Anorexia (nausea and vomiting) Lethargy Tendon reflexes decreased Limp muscles (weakness) Orthostatic hypotension Seizures/headache Stomach cramping

Answer 2

**Sodium** * Plasma sodium concentration \<135 mmol/l * Urinary sodium concentration \>30mmol/L **Osmolality** * Plasma osmolality \<280 mOsmol/kg * Urine osmolality \> 100 mOsmol/kg **Other** * Patient clinically euvolaemic * Absence of clinical or biochemical features of adrenal and thyroid dysfunction. * No diuretic use (recent or past)

Answer 3

**_Treat underlying cause_** **Acute** Hypertonic (3%) saline given via continuous infusion Intravenous furosemide 20 to 40 mg **Chronic** For most other cases of mild-to-moderate SIADH, fluid restriction represents the least toxic therapy, and has generally been the treatment of choice

Answer 4

Primary is a reduction in thyroxin (T4) Secondary is a reduction in TSH

Answer 5

Primary atrophic hypothyroidism (No goitre) Hashimoto’s thyroiditis (Goitre) Iodine deficiency Post-thyroidectomy / radioiodine / antithyroid drugs Lithium / amiodarone

Answer 6

Hypopituitarism

Answer 7

Older Women

Answer 8

**_RS_** Hoarse voice **_GI_** Constipation **_Int_** Cold intolerance **_Endo_** Weight gain **_UG_** Menorrhagia **_MSK_** Myalgia, weakness **_Neuro / Psych_** Tired, low mood, dementia

Answer 9

* *_B_**radycardic * *_R_**eflexes relax slowly * *_A_**taxia (cerebellar) * *_D_**ry, thin hair / skin * *_Y_**awning / drowsy / coma * *_C_**old hands +/- ↓T°C * *_A_**scites * *_R_**ound puffy face * *_D_**efeated demeanour * *_I_**mmobile +/- Ileus * *_C_**CF

Answer 10

**_TFT_** TSH RAISED **_Lipids/cholesterol_** High **_FBC_** Macrocytosis

Answer 11

**_AUTOIMMUNE_** Type 1 Diabetes Mellitus Addison’s disease Pernicious anaemia Primary biliary cirrhosis **_INHERITED_** Turner’s syndrome Down’s syndrome Cystic fibrosis

Answer 12

Levothyroxine (T4) Higher doses in the young

Answer 13

Autoimmune disease T cell mediated attack

Answer 14

Goitre or hypothyroidism or both Enlargement is usually slow and painless but rarely, may be more rapid and painful

Answer 15

The condition may be suspected clinically on the basis of the goitre with or without hypothyroidism. 1. **Serum TSH** is usually raised 2. Measurement of antithyroid antibodies reveal: * *- Thyroid peroxidase antibodies (TPO)** (previously known as thyroid microsomal antibodies) - **TPO** **HIGH titre** * *- Thyroglobulin antibodies (TgAb)** - **HIGH titre** 3. **Biopsy** may be necessary to distinguish it from a carcinoma of the thyroid

Answer 16

If the patient is hypothyroid then oral thyroxine may keep the patient euthyroid and lead to resolution of the goitre.

Answer 17

Too much thyroid hormones

Answer 18

1. GRAVES’ DISEASE 2. TOXIC MULTINODULAR GOITRE 3. EXOGENOUS (Iodine / T4 excess) 4. DE QUERVAIN’S THYROIDITIS (post-viral)

Answer 19

**_CVS_** Palpitations **_GI_** Diarrhoea **_Int_** Heat intolerance **_Endo_** ↓Weight, ↑appetite **_UG_** Oligomenorrhoea +/- infertility **_Neuro / Psych_** Tremor, irritability, labile emotions

Answer 20

**_HANDS_** Palmar erythema; warm, moist skin; fine tremor **_PULSE_** Tachycardia; SVT; AF **_FACE_** Thin hair; lid lag / retraction **_NECK_** Goitre; nodules; bruit

Answer 21

**_TFT_** Increase T4 and T4 **_FBC_** Normocytic anaemia **_ESR (↑)_** **_Calcium (↑)_** **_LFT (↑)_** **_Thyroid autoantibodies_** **_Visual fields, acuity, eye movements_**

Answer 22

**_β-blockers_** Propanolol(rapid control of symptoms) **_Antithyroid medication_** Carbimazole SE = AGRANULOCYTOSIS Block and replace (carbimazole + thyroxine) **_Radioiodine (131I)_** **_Thyroidectomy_**

Answer 23

Autoimmune IgG autoantibodies bind to and stimulate TSH receptors Infection, stress, childbirth

Answer 24

1. Hyperthyroidism 2. Diffuse goitre 3. Extrathyroid features: * **Thyroid acropachy, a triad of:** Digital clubbing Soft tissue swelling of the hands and feet Periosteal new bone formation * **Graves' ophthalmology** - 40% of cases * **Pretibial myxoedema** - 5% of cases * **Thyroid acropachy** - rare * **Onycholysis** - not specific to Grave's!!

Answer 25

* Serum TSH * Free thyroxine (T4) & free or total triiodothyronine (T3 * Serum levels of antibodies to the TSH receptor * Thyroid peroxidase and thyroglobulin autoantibodies * Radioactive iodine uptake and scan * Thyroid ultrasound scan

Answer 26

1. Radioactive iodine - first-line 2. Carbimazole 3. Thyroidectomy

Answer 27

Physiological Graves’ disease Hashimoto’s thyroiditis De Quervain’s

Answer 28

Papillary (60%) Follicular (≤25%) Medullary (5%) Lymphoma (5%) Anaplastic

Answer 29

Low dose radiation Radioiodine A history of radiation exposure to the neck area is associated with increased risk of thyroid cancer

Answer 30

A rapidly growing hard thyroid mass with lymphadenopathy and indicators of extrathyroidal invasion e.g. hoarseness, dysphagia is suggestive of maligancy.

Answer 31

Fine needle biopsy - the most effective method of distinguishing benign from malignant nodules. Tumour products - basal and pentagastrin-stimulated serum calcitonin distinguishes medullary carcinoma. Ultrasound - not useful as a primary test but may help to distinguish cystic lesions Thyroid scanning with radioiodine - thyroid cancer is characteristically Chest X-ray - lung secondaries

Answer 32

Most thyroid tumours are treated surgically with follow up radioiodine ablation

Answer 33

The adrenal glands can't produce enough hormones Aldosterone and cortisol Primary refers to the adrenal glands themselves

Answer 34

**_Cortex_** Zona glomerulosa Zona fasiculata Zona reticularis **_Medulla_**

Answer 35

1. Zona glomerulosa - Aldosterone 2. Zona fasiculata - Cortisol and glucocorticoids 3. Zona reticularis - Make androgens E.g. deyhydroepiandosterone, Precursor to testosterone

Answer 36

Decrease potassium Increase sodium Increase blood volume and pressure

Answer 37

In developed countries **_Autoimmune destruction_** Unclear reason Developing countries **_Tuberculosis_** Infection spreads from lungs to adrenal glands **_Metastatic carcinoma_**

Answer 38

Aldosterone levels fall Leads to high potassium levels in the blood Low sodium - hyponatremia Low sodium water moves out of the blood vessels Hypovolemia High protons in blood Metabolic acidosis since it's caused by the kidneys

Answer 39

Cravings for salty foods Nausea and vomiting Fatigue Dizzyness

Answer 40

Cortisol falls Inadequate glucose levels in times of stress Pituitary glands become overactive Since usually cortisol has negative feedback on pituitary Produces proopiomelinocortin Precursor to ACTH and MSH

Answer 41

Fatigue in times of stress Hyperpigmentation on knuckles and joints

Answer 42

Men not affected Testes major source of male androgens Females Loss of pubic hair decreased sex drive

Answer 43

Symptoms often slow, Major stressor comes along Injury, surgery or infection Cause symptoms to appear Sudden need for aldosterone and cortisol

Answer 44

**_ACTH hormone test_** Small amount of synthetic ACTH injected Measure cortisol and aldosterone produced Both will be low **_Bloods_** FBC(anaemia, eosinophilia) U&E(↓Na+, ↑K+, ↑Ca2+, ↑Urea) BM(↓)

Answer 45

Homones Cortisol - hydrocortisone Aldosterone - Fludrocortisone Androgens Take for life Stopping can lead to crisis

Answer 46

1. Double the glucocorticoid 2. Keep the fludrocortisone dose the same

Answer 47

Addisonian crisis (acute primary adrenal insufficiency)

Answer 48

Waterhouse-friderichsen syndrome Causes blood vessels in adrenal glands to rupture

Answer 49

Pain in back abdomen or legs Vomiting and diarrhoea leading to dehydration Low blood pressure leading to loss of consciousness Death

Answer 50

Lack of ACTH and therefore cortisol

Answer 51

**_Medications_** Glucocorticoids Pituitary mass or infection

Answer 52

Aldosterone secretion independent of ACTH

Answer 53

Features common to both primary and secondary hypoadrenalism include: 1. Lassitude and muscle weakness and pain 2. Hypotension 3. Gastro-intestinal symptoms - anorexia, weight loss, nausea and vomiting, intermittent abdominal pain salt, craving 4. Decrease in axillary and pubic hair - common in women 5. Depression Pigmentation only occurs in primary hypoadrenalism, due to high ACTH: 1. The skin assumes a dull, grey-brown colouration 2. Exposed skin, pressure areas, palmar creases, knuckles, buccal mucosa and recent scars are the commonest sites

Answer 54

**_Bloods_** Low cortisol

Answer 55

**Glucocorticoid analogues - hydrocortisone** 10mg in morning, 5 mg at midday, 5mg in evening. **Fludrocortisone**

Answer 56

Hyperaldosteronism

Answer 57

Adrenal adenima Bilteral adrenal nodular hyperplasia

Answer 58

Potassium low Sodium high Less protons

Answer 59

Hypertension Metabolic alkolosis

Answer 60

Headaches and flushing Constipation Weakness Heart rhythm changes

Answer 61

**_FIRST LINE ALDOSTERONE/RENIN RATIO - Bloods_** High levels of aldosterone Low levels of renin **Differentiate between adenoma and hyperplasia** CT Hypokalaemia\*- ensuring absence of diuretics, steroids, laxatives Hypernatraemia - sodium may be mildly elevated or normal Hypertension Metabolic alkalosis

Answer 62

**_Potassium sparing diuretic_** Spirinolactone **_Surgery_** Remove tumour

Answer 63

Trouble moving glucose from blood into cells High level in blood Not alot in cells

Answer 64

Type 1 10% Type 2 90%

Answer 65

Bodies own cells attack the pancreas Type 4 hypersensitivty reaction Cell-mediated response

Answer 66

Polydipsia Polyuria, with associated nocturia or enuresis Glycosuria Weight loss due to dehydration and catabolism Polyurea, polydipsia (due to osmotic diuresis), polyphagia, Constipation Fatigue Cramps Blurred vision Bacterial and fungal infections e.g. - candidiasis

Answer 67

Vascular disease Nephropathy Neuropathy Diabetic foot Retinopathy

Answer 68

Diabetes is diagnosed on the basis of history (ie polyuria, polydipsia and unexplained weight loss) PLUS a random venous plasma glucose concentration \>= 11.1 mmol/l OR a fasting plasma glucose concentration \>= 7.0 mmol/l (whole blood \>= 6.1 mmol/l) OR 2 hour plasma glucose concentration \>= 11.1 mmol/l 2 hours after 75g anhydrous glucose in an oral glucose tolerance test (OGTT) an HbA1c of 6.5% (48 mmol/mol) is recommended as the cut point for diagnosing diabetes (i.e. HbA1c \>= 6.5% (48 mmol/mol) is sufficient for the diagnosis of diabetes)

Answer 69

Lifelong insulin injections Education

Answer 70

Hypoglycaemia Hyperglycaemia Diabetic ketoacidosis Hyperosmolar non-ketotic hyperglycemia

Answer 71

Biochemical triad of 1. Ketonaemia 2. Hyperglycaemia 3. Acidaemia

Answer 72

Make the blood acidic Kussmaul respiration Deep/labored breathing To reduce CO2 Reduce acidity

Answer 73

A stress e.g. infection Release of epinephrine Release of glucagon More glucose in blood Loss of glucose in urine Loss of water Dehydration Need for alternative energy Generation of ketone bodies

Answer 74

1. **Polyuria with polydipsia** – commonest presenting symptom 2. Fatigue 3. Dyspnea 4. Vomiting 5. Preceding febrile illness 6. Abdominal pain 7. Polyphagia 8. **Kussmaul respirations** 9. **Acetone breath**

Answer 75

Acetone Fruity smell

Answer 76

Nausea Vomiting Mental status changes Cerebral oedema

Answer 77

1. Serum glucose level Usually greater than 250 mg/dL (13.9 mmol/L) 2. Arterial blood gas measurement pH varies from 7.00 to 7.30 3. Serum electrolytes Bicarbonate level - \<18 mmol/L (18 mEq/L) Serum sodium level - usually low Serum potassium - may be low, normal, or elevated Magnesium – usually low but can be normal 4. Blood urea nitrogen, creatinine levels 5. Serum ketone level 6. Urinalysis Confirms the presence of glucose and ketones Positive for leukocytes and nitrites in the presence of infection

Answer 78

1. Ketonaemia 3 mmol /l and over or significant ketonuria (more than 2 + on standard urine sticks) 2. Blood glucose over 11 mmol /l or known diabetes mellitus 3. Venous bicarbonate (HCO3 ) ) below 15 mmol /l and /or venous pH less than 7.3

Answer 79

Fluids for dehydration - 0.9% sodium chloride Insulin to lower blood glucose - 0.1 units/kg Glucose when blood glucose falls below 14mmol/l Electrolytes (K+)

Answer 80

Body makes insulin but the cells don't respond Not fully understood

Answer 81

Obesity Lack of exercise Hypertension

Answer 82

Insulin levels high when cells don't respond to insulin Blood glucose levels remain normal

Answer 83

polydipsia polyuria, with associated nocturia or enuresis glycosuria

Answer 84

**_Fasting glucose_** No food or drink for 8 hours 7 mmol/l or over indicates diabetes **_Non-fasting or random glucose_** Over 11.1 mmol/l **_Oral glucose tolerance_** Over 11.1 mmol/l at 2 hours **_HbA1C_** Percentage or red blood cells with glucose on 48 or higher

Answer 85

1. Metformin 2. SU - e.g. Glipizide 3. DPP-4i - GLIPTINS 4. Pioglitazone 5. SGLT-2i - GLIFLOZINS

Answer 86

Retinopathy Kidneys Nephrotic syndrome Nerves Decrease in sensation Stocking-glove distribution

Answer 87

Improves insulin sensitivity by 1. **Actions upon the liver:** reducing hepatic gluconeogenesis and glycogen breakdown 2. **Actions upon skeletal muscle and adipose tissue:** increasing insulin-stimulated glucose uptake and oxidation and, in muscle, increasing glycogen formation

Answer 88

Augmentation of secretion of insulin from pancreatic beta-cells. Sulphonylureas may also cause a reduction in serum glucagon and potentiate the action of insulin at the extrapancreatic tissues WEIGHT GAIN

Answer 89

In response to a meal, glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic peptide (GIP) are released (these hormones are termed incretin hormones) these incretin hormones stimulate insulin and suppress glucagon release (both in a glucose-dependent manner), delay gastric emptying, and increase satiety incretins are rapidly degraded by dipeptidyl peptidase-4 (DPP-4) DPP-4 inhibitors are a class of oral antihyperglycemic agents that work via slowing incretin degradation DPP-4 inhibitors enhance meal-stimulated active GLP-1 and GIP levels by two- to threefold

Answer 90

Factors favouring type 1 rapid onset of osmotic symptoms normal or low body weight or rapid weight loss ketonaemia \>=3mmol/l on capillary testing or ketonuria family or personal history of other autoimmnune conditions failure to respond to oral therapy positive antibody test (anti-GAD, insulin autoantibodies (IAA) and islet cell antibodies (ICA) most commonly used) urine C-peptide:creatinine ratio less than 0.5nmol/l

Answer 91

Extreme elevations in serum glucose concentrations, hyperosmolality and dehydration without significant ketosis

Answer 92

Hyperglycaemia Dehydration with marked thirst Marked drowsiness Weakness Visual disturbance Leg cramps Nausea and vomiting - less frequent than in patients with DKA

Answer 93

plasma glucose concentration \>33.3 mmol/L (600 mg/dL) arterial pH \> 7.30; venous pH \> 7.25 serum bicarbonate \>15 mmol/L small ketonuria, absent to small ketonemia effective serum osmolality \>320 mOsm/kg obtundation, combativeness, or seizures (in approximately 50%)

Answer 94

Fluids 0.9% sodium chloride Insulin 0.1/kg blood glucose insulin rate (u/hour) \>20 - 3 13-20 - 2 5-13 - 1 \<5 - 0.5 If potassium low give them infusion

Answer 95

Specific type of tumour Causes neuroendocrine cells to secrete hormones * *_Syndrome_** * *D**iarrhoea * *F**lushing * *S**OB

Answer 96

Epithelial layer of GI organs and lungs Kulchitsky cells Mid-gut Hind-gut

Answer 97

**_Nerves_** 1. Serotonin 2. Histamine 3. Bradykinin 4. Prostaglandins

Answer 98

1. Paroxysmal flushing - for example, following coffee, alcohol, certain foods and drugs 2. Bronchoconstrictive episodes, similar to asthma 3. Right-sided heart failure 4. Episodes of explosive watery diarrhoea 5. Abdominal pain 6. Pellagra-like lesions of the skin and oral mucosa

Answer 99

**_Urinalysis_** 5-hydroxyindoleacetic acid (5-HIAA) **Plasma Chromogranin A (CgA)** **_Octreoscan_** Inject radioactive labelled octreotide Binds to increase number of somatostatin **_Blood tests_** Niacin deficiency

Answer 100

**_Somatostatin analogues_** Octreotide **_Decrease_** Emotional stress Alcohol **_Carcinoid tumour_** Surgery Chemo

Answer 101

Lack of ADH

Answer 102

Water not sufficiently reabsorbed from collecting duct Large amounts of undilute urine

Answer 103

1. Polydipsia 2. Polyuria 3. Dehydration 4. Hypernatremia

Answer 104

**_Central problem with hypothamus and pituitary_** ADH low **_Nephrotic problem with kidneys_** ADH high

Answer 105

1. Tumour 2. Lack of blood supply (inc Sheehan’s) 3. Impact/fracture 4. Surgical 5. Autoimmune

Answer 106

1. Lithium toxicity 2. Release of obstruction 3. Hypercalcemia 4. Hypokalaemia

Answer 107

Give desmopressin If urine output falls, osmolality increases Suggests central

Answer 108

**_Central_** Desomopressin 5-40mg intranasally **_Diuretics_** Hydrocholorothiazide

Answer 109

Promote water AND SALT LOSS Activate RAAS!!

Answer 110

Release parathyroid hormone 1. Increases bone resorption 2. Increases calcium absorption in kidneys 3. Increases Vit D synthesis in kidney * Vit D increases GI absorption

Answer 111

Calcitoin Increase bone deposition Decrease kidney absorption of calcium

Answer 112

Increase in parathyroid hormone

Answer 113

**_Primary_** Adenoma **_Secondary_** PTH is high to attempt to correct persistently low calcium levels **_Tertiary_** After many years of uncorrected secondary hyperparathyroidism

Answer 114

STONES, BONES and GROANS **_Increased Ca2+_** Weak, tired, depressed, thirsty, renal stones, abdopain. **_Bone resorption_** Pain, fractures, osteopenia/porosis. **_Increased BP_** Check Ca2+ in hypertension.

Answer 115

**_PTH_** High **_Calcium_** High **_Phosphate_** Low **_Phosphatase_** High

Answer 116

Treat underlying cause

Answer 117

**_CKD_** **_vit D deficiency_** GI disease such as bypass and Crohn’sare also possible

Answer 118

Bony Osteomalacia

Answer 119

**_PTH_** High **_Calcium_** Low **_Phosphate_** High **_Phosphatase_** High

Answer 120

Treat underlying cause Bisphosphonates

Answer 121

Low levels of parathyroid hormone

Answer 122

**_Primary_** AI, congenital (Di George syndrome) **_Secondary_** Radiation, surgery, hypomagnesaemia

Answer 123

Hypocalcaemia SPASMODIC Spasms Trousseau’s on inflation of cuff anxious seixures Chvostek’s – tap facial nerve over parotid – corner of mouth twitches.

Answer 124

Ca2+ supplements Calcitriol (prevents hypercalciuria)

Answer 125

Catecholamine secreting tumour

Answer 126

hypertension (around 90% of cases, may be sustained) headaches palpitations sweating anxiety

Answer 127

24 hr urinary collection of metanephrines replaced 24hr collection of catecholamines

Answer 128

1. Surgery is definitive 2. Alpha-blocker (e.g. **phenoxybenzamine**) before 3. Beta-blocker (e.g. **propranolol**)

Endocrinology Flashcards

(153 cards)