Endocrinology Flashcards
(104 cards)
1
Q
FLAT PIG for anterior pituitary hormones
A
FSH
LH
ACTH
TSH
PRL
Intermediate - MSH
GH
2
Q
too much hormone
A
try to suppress it
3
Q
too little hormone
A
try to stimulate it
4
Q
what imaging modalities would you use for adrenals and pituitary
A
CT - adrenal
MRI - pituitary
5
Q
approaches to endocrine
A
phenotype
biochemistry: suppression/stimulation tests, levels
imaging
6
Q
phenotype of hyperthyroidism
A
heat intolerance weight loss anxiety tremor tachycardia palpitations diarrhoea oligo/amenorrhoea exophthalmos dry skin and fine brittle hair pretibial myxoedema insomnia AF
7
Q
biochemistry of primary hyperthyroidism
A
low TSH
high free T3/4
8
Q
primary hyperthyroidism
A
problem with the thyroid itself resulting in negative feedback
9
Q
secondary hyperthyroidism
A
pituitary abnormality resulting in thyroid abnormality
10
Q
causes of primary hyperthyroidism
A
Graves disease TMG Adenoma Thyroiditis drugs - amiodarone
11
Q
what is Graves disease
A
autoimmune condition
anti-TRAb - thyroid receptor antibodies
continuously stimulates iodine uptake into thyroid and production of T3/4
smooth goitre with bruit
12
Q
features pathognomonic of Graves
A
pretibial myxoedema
Graves ophthalmopathy - asymmetrical swelling and exophthalmos
thyroid acropachy
13
Q
management of sight threatening swelling of the eye
A
steroids
14
Q
investigations for hyperthyroidism
A
thyroid levels
USS
nuclear medicine uptake scan
15
Q
which ATD is used in the first trimester of pregnancy
A
PTU
16
Q
ATD examples
A
carbimazole
PTU
17
Q
management of hyperthryoidism
A
propranolol for symptoms (non-selective B blocker)
carbimazole, PTU
radioactive iodine
thyroidectomy
18
Q
side effects of carbimazole and PTU
A
carbimazole - agranulocytosis
PTU - liver failure
19
Q
risks of thyroidectomy
A
RLN damage
damage to parathyroids
20
Q
thyroid storm
A
extreme hyperthyroidism
21
Q
features of thyroid storm
A
high temp dehydration excess sweating sinus arrhythmia diarrhoea pre renal failure weight loss myopathy CK rise delirious coma psychosis
22
Q
management of thyroid storm
A
1. propranolol PTU/carbimazole hydrocortisone 2. iodine lithium look for underlying causes
23
Q
phenotype hypothyroidism
A
weight gain cold intolerance low mood low energy bradycardia constipation menorrhagia
24
Q
biochemistry of primary hypothyroidism
A
high TSH
low free T3/4
25
causes of primary hypothyroidism
```
autoimmune Hashimoto's
thyroiditis
post-hyperthyroidism treatment
iodine deficiency
amiodarone
lithium
interferon
irradiation
sarcoidosis
amyloidosis
surgery
```
26
management of hypothyroidism
levothyroxine
27
worry abut levothyroxine in elderly
suddenly increase their heart function which can exacerbate heart conditions eg HTN, HF
28
what is myxoedema coma
extreme hypothyroidism
29
features of myxoedema coma
```
depressed
thinning hair
oedema
bradycardia
constipation
carpal tunnel
cool peripheries
hypothermia
loss of outer 1/3rd eyebrow hair
```
30
management of myxoedema coma
levothyroxine
| steroids
31
hypothyroidism causes high/low MCV
high
32
symptoms of hypercalcaemia
```
bones - bone pain
moans - psychiatric
stones - renal
groans - abdo pain
thrones - constipation
dehydration and thirst
confusion
polyuria
myopathy
depression
short QT segment - ECG
```
33
treatment of acute hypercalcaemia
0.9% NaCl
IV bisphosphonates
identify cause and reverse it
34
symptoms of hypocalcaemia
```
paraesthesia
Trousseau sign - carpopedal spasm
Chovsteks sign - twitching on tapping face
tetany
long QT segment - ECG
fatigue and muscle weakness
fits, seizures
```
35
treatment of acute hypocalcaemia
IV calcium gluconate 10ml, 10% over 10 min
36
management of acute hyperkalaemia
```
ECG
stop any infusion containing K
IV calcium gluconate to stabilise cardiac membrane
IV insulin to drive K intracellularly
salbutamol does the same
haemodialysis is a last line
```
37
phenotype of reduced anterior pituitary function
large tumour bulk - adenoma - cause reduction in hormone production and therefore function
38
causes of hypopituitarism
tumours - adenoma, craniopharyngeoma
vascular - Sheehans syndrome, severe hypotension
infection - meningitis, TB, syphilis, HIV/AIDS
hypothalamic disorders - tumours, functional, GHRH deficiency
iatrogenic - radiation, hypophysectomy
miscellaneous - sarcoidosis, haemochromatosis
39
features of hypopituitarism
secondary amenorrhoea in premenopausal women
| bitemporal hemianopia
40
general order of loss of pituitary function
```
GGAT
Gonadotrophins
GH
ACTH
TSH
```
41
low LH and FSH is a post menopausal woman is a red flag?
yes
| normally a post menopausal woman should have high LH and FSH and so if it low it might be due to a pituitary pathology
42
stimulation test for GH
insulin tolerance test
| insulin to bring down blood glucose to stimulate GH
43
in anterior pituitary hormone excess, it generally occurs to all hormones produced, true or false
false
| usually one hormone goes beserk
44
most common cause of hormone excess in anterior pituitary
adenoma
45
FSH/LHomas tend to be detected quite late, true or false
true
usually removed surgically
can cause hypopituitarism
46
features of ACTH excess
```
Cushingoid appearance
weight gain, puffy face, central obesity, striae
thin skin, bruising, hirsutism, muscle wasting, osteoporosis, frontal balding, acne, buffalo hump
poor healing
thin limbs
^HTN
^blood glucose
fluid retention
depression, psychotic, poor sleep
immunosuppression
```
47
causes of Cushing's
exogenous steroid use
Pituitary - Cushing's disease
adrenal adenoma / hyperplasia
ectopic - SCLC
48
investigation for excess cortisol
DXM suppression test
| very potent steroid to feedback to pituitary to switch off ACTH and down regulate cortisol
49
adrenal anatomical regions
```
cortex outside (secretory)
medulla inside (neuroendocrine)
```
50
layers of the cortex
```
GFR
zona:
glomerulosa
fasiculata
reticularis
```
51
what does zona glomerulosa secrete
aldosterone - minerlocorticoid
52
what does the zona fasiculata secrete
cortisol - corticosteroid
53
what does the zona reticularis secrete
adrenal androgens
| - fairly clinical insignificant
54
what does the adrenal medulla secrete
adrenaline
noradrenaline
- catecholamines
55
what are steroid ultimately derived from
cholesterol --> pregnenolone --> steroid
56
only glucocorticoids negatively feedback on ACTH, true or false
true
57
what do the mineralocorticoids negatively feedback on
RAAS
58
What is a cause of hypoadrenalism
```
Autoimmune Addisons disease
Malignancy
Freiderichson-Waterhouse syndrome - haemorrhage/hypotension
Infections - TB, HIV
Excess steroid therapy
Haemochromatosis
```
59
clinical features of hypoadrenalism
```
hypotension
dizzy
weight loss
tanned / hyperpigmentation of creases
hypoglycaemia
diarrhoea
```
60
why do people with hypoadrenalism have tanned skin
^ ACTH production results in ^MSH causing bronzed skin
61
why would you do a BM in someone with hypoadrenalism
low cortisol causes low glucose
62
biochemical features of hypoadrenalism
hyponatraemia
hyperkalaemia
hypoglycaemia
low early morning cortisol
63
dynamic testing for hypoadrenallism
synacthen test
give dose of ACTH to see whether there is a spike in cortisol levels
take bloods at 0, 30 and 60 min
(also measure ACTH at 0 min)
64
further imaging for hypoadrenalism
CT adrenal
65
management of hypoadrenalism
hydrocortisone (cortisol replacement)
| fludrocortisone (aldosterone replacement)
66
if patients are acutely unwell and have hypoadrenalism, what is important to have
steroid card and emergency hydrocortisone
67
what adrenal gland hormones can you have too much of
aldosterone
cortisol
catecholamines
68
function of aldosterone
mineralocorticoid
activates Na/K ATP channel and resorb Na at the kidney
water follows Na resulting in increased circulating blood volume and maintains BP
69
what is the RAAS
Angiotensinogen is produced in the liver
Renin from the kidneys break this down into Ag I
ACE then breaks this into Ag II
Ag II then acts on the kidneys to resorb Na and causes
70
What is Conns syndrome
excess aldosterone
71
clinical features of aldosterone excess
treatment resistant HTN
72
biochemistry of aldosterone excess
hypokalaemia
| technically hypernatraemia but because water follows Na, Na levels remain normal
73
dynamic testing for aldosterone excess
renin:aldosterone ratio
renin low
aldosterone high
74
what suppression test do you do for aldosterone excess
2L saline suppression test
75
examples of aldosterone antagonist drugs
spironolactone
| eplerenone
76
why do people with Conns disease cause hyperchloraemic metabolic alkalosis
hyperchloraemia
| aldoseterone causes retention of HCO3 and loss of H
77
people with addisons disease get metabolic acidosis/alkalosis
acidosis
78
treatment of Conns disease
surgical removal of Conns tumour
| or spironolactone treatment
79
what adrenal disease causes cortisol excess
Cushing's syndrome
80
phenotype of Cushings syndrome
```
buffalo hump
central obesity
limb muscle weakening - proximal myopathy
frontal balding
striae
moon face
hypertension
IGT
thin skin, easy bruising
```
81
dynamic testing for cushings
DXM suppression test
82
```
response to DXM suppression test in:
adrenal
pituitary
ectopic
as a cause of Cushings
```
adrenal - suppressed in low dose DXM
pituitary - suppressed in high dose DXM
ectopic - very high, no suppression
83
drug for cushings syndrome
metyrapone
| only used for elderly people
84
what disease is caused by excess catecholamines
phaeochromocytoma
| tumour of chromaffin cells
85
clinical features of phaeochromocytoma
```
headaches
hyperglycaemia
sweating
palpitations
pallor
hypertension
postural symptoms
episodic symptoms
```
86
investigation for excess catecholamines
24 hour urine metanephrine collections
(2 collections)
plasma also (2nd line test)
87
medical management of phaeochromocytoma and why
alpha (phenoxybenzamine/doxazosin) then beta blockers
alpha receptors are in blood vessels
beta receptors are in the heart
this should be done before surgery to prevent squeezing out pre formed hormones causing a crash response
88
why alpha then beta blockade in phaeochromocytoma
blocking beta first would mean that adrenaline would saturate the alpha receptors and cause extreme vasoconstriction and hypertension
89
functional imaging for phaeochromocytoma
MIBG scan
90
10% rule for phaeochromocytoma
```
bilateral
malignant
genetic
kids
extra adrenal
```
91
which vitamin is essential for Ca metabolism
Vit D3
92
which mineral is important for calcium regulation
Mg
| without it, PTH cannot be released or work properly
93
how many parathyroid glands in the body
4
94
where does PTH act
bone - osteoclasts activates
kidneys - increased Ca resorption and decreased PO4
gut - increased Ca + PO4 reabsorption
95
classifications of parathyroidism
primary
secondary
tertiary
96
primary hyperparathyroidism
idiopathic inappropriate secretion of PTH
^PTH + Ca
low PO4
97
secondary hyperparathyroidism
appropriate hypersecretion of PTH secondary to low Ca
^PTH
low Ca and PO4
98
tertiary hyperparathyroidism
autonomous hypersecretion of PTH / 2ndary HPT gone beserk
| most commonly seen in CKD
99
phenotype of hypercalcaemia
```
bones - osteoporosis
stones - renal
groans - abdominal
moans - psychiatric
thirsty polydipsia
polyuria
```
100
imaging for parathyroids
sestamibi scan
101
causes of hypercalcaemia
```
Endocrine - HPT, MEN, FHH
Malignancy - mets, PTHrp, myeloma
Granulomatous disease - sarcoid, TB
miscellaneous - AKI, milk alkali syndrome
Medications - lithium, thiazides, vit D
```
102
first investigation in someone with hypercalcaemia
PTH levels
103
management of hypercalcaemia acutely
IV fluids
| bisphosphonates
104
addisons can cause hypercalcaemia?
yes
