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Endocrine > Endocrinology causes COPY > Flashcards

Endocrinology causes COPY Flashcards

1
Q

Causes of thyrotoxicosis with low radioactive iodine uptake

A
  • Painless thyroiditis (silent thyroiditis, lymphocytic thyroiditis, subacute
    lymphocytic thyroiditis & postpartum thyroiditis)
  • Subacute (de Quervain’s) thyroiditis (subacute granulomatous thyroiditis)
  • iatrogenic (eg, lithium, amiodarone, iodine, interferon alpha, interleukin 2)
  • Factitious ingestion of levothyroxine (T4) &/or triiodothyronine (T3)
  • Struma ovarii
  • Acute thyroiditis
  • Extensive thyroid cancer metastases
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2
Q

Causes of central diabetes insipidus

A
  • Autoimmune hypophysitis (idiopathic)
  • Malignancy (metastatic or primary)
  • Neurosurgery
  • Infiltration
    • sarcoidosis,
    • histiocytosis X,
    • lymphocytic hypophysitis,
    • granulomatosis with polyangiitis,
    • IgG4-related disease
  • Trauma
  • Following correction of supraventricular tachycardia
  • Hypoxic encephalopathy
  • Anorexia nervosa
  • Sheehan syndrome
  • Familial
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3
Q

Graves disease (specific signs)

A
  • Clubbing
  • Thyroid bruit
  • Exophthalmos
  • Pretibial myxedema
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4
Q

Graves disease associations

A
  • Ophthalmopathy with exophthalmos/proptosis
  • Skin abnormalities such as pretibial myxedema
  • Digital clubbing (acropachy)
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5
Q

Lower-than-expected levels of HbA1c (due to reduced red blood cell lifespan)

A
  • Sickle-cell anaemia
  • GP6D deficiency
  • Hereditary spherocytosis
  • Hbc, HbS
  • Hemolytic anemia
  • Blood loss
  • Blood transfusion
  • Renal failure
  • Dapsone
  • Pregnancy
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6
Q

Higher-than-expected levels of HbA1c (due to increased red blood cell lifespan)

A
  • Vitamin B12/folic acid deficiency
  • Iron-deficiency anaemia
  • Splenectomy
  • HbF or HbG
  • Hypertriglyceridemia
  • Alcohol
  • High Bilirubin
  • Aspirin
  • Splenectomy, aplastic Anemia
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7
Q

Causes of secondary amenorrhea (after excluding pregnancy)

A
  • hypothalamic amenorrhea (e.g. Stress, excessive exercise)
  • hyperprolactinaemia
  • thyrotoxicosis
  • polycystic ovarian syndrome (PCOS)
  • premature ovarian failure

hypothyroidism may also cause amenorrhea

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8
Q

Causes of low estradiol and low or inappropriately normal FSH and LH (hypogonadotrophic hypogonadism)

A
  • hypothyroidism
  • hyperprolactinemia
  • hypothalamic (stress, weight loss, exercise)
  • pituitary (tumor, Sheehan syndrome)

A progesterone challenge test is performed in the above situations, if:

  • No bleeding following a progesterone challenge indicates low estrogen because of hypothalamic hypogonadism; measure estradiol level to confirm.
  • Bleeding following progesterone challenge indicates a normal estrogen state and suggests possible hyperandrogenism (e.g., PCOS).
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9
Q

Oral diabetes medications that do not cause weight gain or hypoglycemia

A
  • biguanides (such as metformin),
  • sodium-glucose cotransporter-2 inhibitors,
  • the glucagon like peptide-1 receptor agonists
  • dipeptidyl peptidase-4 inhibitors (such as sitagliptin).
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10
Q

Agents which interfere with thyroxine absorption

A
  • binding agents such as cholestyramine and sevelamer,
  • iron sulphate
  • proton pump inhibitors.
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11
Q

Causes of hypoparathyroidism

A
  • Idiopathic,
  • DiGeorge syndrome,
  • hypomagnesemia,
  • secondary to surgery or neck irradiation
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12
Q

Causes of nephrogenic diabetes insipidus

A
  • Lithium
  • Other medications (demeclocycline, cidofovir, foscarnet, didanosine, amphotericin B, ifosfamide, ofloxacin)
  • Electrolyte disorders (hypercalcemia, hypokalemia)
  • Urinary tract obstruction
  • Sickle cell nephropathy
  • Amyloidosis
  • Sjögren syndrome
  • Nephronophthisis
  • Cystinosis
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13
Q

Causes of gynaecomastia

A
  • physiological: normal in puberty
  • syndromes with androgen deficiency: Kallman’s, Klinefelter’s
  • testicular failure: e.g. mumps
  • testicular cancer e.g. seminoma secreting HCG
  • ectopic tumour secretion
  • hyperthyroidism
  • liver disease
  • haemodialysis
  • drugs:
    • spironolactone (most common drug cause)
    • digoxin
    • cimetidine
    • cannabis
    • finasteride
    • gonadorelin analogues e.g. Goserelin, buserelin (Goserelin is a gonadorelin analogue used in the treatment of advanced prostate cancer. )
    • oestrogens, anabolic steroids

OnExamination

Drugs that induce gynaecomastia include inhibitors of testosterone synthesis:

  • ketoconazole
  • metronidazole
  • cimetidine
  • etomidate, and
  • cisplatin.

Oestrogens:

  • digitalis, and
  • oral contraceptive pill.

Other drugs in which the mechanism is not known include:

  • isoniazid
  • diazepam
  • omeprazole
  • calcium-channel blockers
  • ACE inhibitors
  • amiodarone
  • tricyclic antidepressants
  • busulfan
  • marijuana
  • heroin, and
  • spironolactone.
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14
Q

Causes of low TSH and low free T4

A
  • Central hypothyroidism
  • Subclinical thyrotoxicosis
  • Euthyroid sick syndrome
  • Medications
    • dopamine
    • high-dose glucocorticoids
    • octreotide
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15
Q

Drug causes of raised prolactin

A
  • metoclopramide,
  • domperidone
  • phenothiazines
  • haloperidol
  • very rare: SSRIs, opioids
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16
Q

Most specific Cushing clinical manifestations

A
  • proximal myopathy,
  • rounded facies,
  • facial plethora,
  • wide purple striae
17
Q

Medications that can cause false negative renin:aldosterone ratio results

A
  • Direct renin inhibitors (e.g aliskiren).
  • Angiotensin-converting enzyme inhibitors (e.g. ramipril or lisinopril).
  • Angiotensin receptor blockers (e.g. losartan).
  • Aldosterone antagonists (e.g. spironolactone or eplerenone).
18
Q

DM drugs which cause hypoglycaemia + weight gain

A
  • sulfonylureas
  • meglitinides
  • Insulin
19
Q

Causes of raised prolactin

A
  • prolactinoma
    • in males it is macroadenoma so it cause bitemporal hemianopsia
    • in female it is microadenoma
  • pregnancy
  • oestrogens
  • physiological: stress, exercise, sleep
  • acromegaly: 1/3 of patients
  • polycystic ovarian syndrome
  • primary hypothyroidism (due to thyrotrophin releasing hormone (TRH) stimulating prolactin release)
20
Q

Causes of male hypogonadism

A
  • Elevated LH and FSH values indicate primary testicular failure. Some common causes include:
    • Klinefelter syndrome (check karyotype)
    • atrophy secondary to mumps orchitis
    • autoimmune destruction
    • previous chemotherapy or pelvic irradiation
    • hemochromatosis
  • Low or normal LH and FSH levels indicate secondary hypogonadism. Important causes include:
    • sleep apnea
    • hyperprolactinemia
    • hypothalamic or pituitary disorders (hemochromatosis, pituitary/hypothalamic tumor)
    • use of opiates, anabolic steroids, or glucocorticoids
21
Q

Autoimmune (Hashimoto) thyroiditis associations

A
  • Antithyroperoxidase antibodies
  • Antithyroglobulin antibodies
  • Positive ANA
22
Q

Causes of primary amenorrhea

A
  • Turner’s syndrome
  • Androgen insensitivity syndrome (testicular feminization TFS)
  • congenital adrenal hyperplasia CAH
  • congenital malformations of the genital tract
23
Q

Antidiabetic medications with proven cardiovascular benefit

A
  • metformin
  • some glucagon-like peptide-1 (GLP-1) agonists, including liraglutide and semaglutide
  • the SGLT-2 inhibitors canagliflozin and empagliflozin.
24
Q

Causes of drug-induced impaired glucose tolerance

A
  • thiazides, furosemide (less common)
  • steroids
  • Calcineurin Inhibitors (tacrolimus, ciclosporin)
  • interferon-alpha
  • nicotinic acid
  • atypical antipsychotics e.g. olanzapine
  • Beta-blockers cause a slight impairment of glucose tolerance.
  • Glucocorticoids
  • Pentamidine
  • Nicotinic acid
  • Levothyroxine
  • Diazoxide
  • Octreotide
  • Thiazides
  • Pressors
  • Pyrazinamide
25
Q

Causes of low estradiol and elevated FSH and LH levels (hypergonadotrophic hypogonadism)

A
  • premature ovarian insufficiency (autoimmune)
  • chemotherapy
  • pelvic radiation
26
Q

Secondary DM causes

A
  • Acromegaly
  • Cushing syndrome
  • Hyperthyroidism
  • Somatostatinoma
  • Aldosteronoma

Endocrinopathies:

  • Acromegaly
  • Cushing syndrome
  • Glucagonoma
  • Pheochromocytoma
  • Hyperthyroidism
  • Somatostatinoma
  • Aldosteronoma
27
Q

Causes of primary hypogonadism in males

A

Congenital abnormalities:

  • Klinefelter syndrome (and other chromosomal abnormalities)
  • Myotonic dystrophy.
  • Mutation in the FSH and LH receptor genes
  • Cryptorchidism
  • Varicocele
  • Disorders of androgen synthesis

Acquired diseases:

  • Infections (especially mumps)
  • Radiation
  • Trauma
  • Testicular torsion
  • Alkylating agents
  • Ketoconazole, Glucocorticoids, Environmental toxins
  • Autoimmune damage
  • Chronic systemic illnesses
  • Hepatic cirrhosis, Chronic renal failure
  • AIDS
  • Idiopathic.
28
Q

Hirsutism causes

A

Polycystic ovarian syndrome is the most common cause of hirsutism.

Other causes include:

  • Cushing’s syndrome
  • Congenital adrenal hyperplasia CAH
  • Androgen therapy
  • Obesity: due to peripheral conversion oestrogens to androgens
  • Adrenal tumour
  • Androgen secreting ovarian tumour
  • Drugs: phenytoin, corticosteroids
29
Q

Hormones secreted by the anterior pituitary gland

A
  • ACTH,
  • TSH,
  • luteinizing hormone,
  • follicle-stimulating hormone,
  • prolactin,
  • growth hormone, and
  • melanocyte-stimulating hormone

MCQ

30
Q

Hormones released by the posterior pituitary gland

A
  • Oxytocin
  • Vasopressin (ADH)
31
Q

Secondary hyperaldosteronism

A
  • Renovascular disease
  • CHF, cirrhosis, nephrotic
  • Hypovolemia & diuretic use
  • Bartter’s syndrome
  • Gitelman’s syndrome
  • Renin-secreting tumor
32
Q

Thyroid storm: drugs that block conversion of T4 into T3

A
  • Propylthiouracil (PTU),
  • Propranolol
  • Corticosteroids (hydrocortisone)

Endocrine (5 decks)

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