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RCPCH TAS/ AKP > Endocrinology & Diabetes > Flashcards

Endocrinology & Diabetes Flashcards

(62 cards)

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1
Q

Effects of increased cortisol in the body

A

Increased BP
Increased gluconeogenesis, lipolysis, proteolysis
Anti-inflammatory
Reduced bone function, immunity

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2
Q

Which areas of the adrenal gland produce which hormone?

A

Medulla: Adrenaline, noradrenaline

Cortex: (out to in)
- Glomerulus - Mineralocorticoids (aldosterone)
- Fasiculata - Glucocorticoids (cortisol)
- Reticular - Sex (androgens)
Go Find Rex, Make Good Sex

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3
Q

What controls calcium homeostasis in the body?

A
  1. Low calcium
  2. Parathyroid releases more PTH
  3. Acts in 3 places:
    -Bones - osteoclasts break down bone
    - Kidneys - retain Ca2+ and Vit D
    - Intestines - absorb more Ca2+

Mg2+ also regulates PTH release

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4
Q

What controls the release of sex hormones?

A
  1. Hypothalamus releases GnRH
  2. Ant. Pituitary releases LH / FSH
  3. In males –> LH –> Testes release Testosterone and FSH stim. sperm maturation
  4. In females –> LH and FSH –> ovaries release estradiol and progesterone
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5
Q

What biochemical changes would you see in different types of Hypothyroidism?

A
  1. Primary = High TSH, low T3/T4
  2. Secondary = Low TSH, T3/4
  3. Treated / subclinical= High TSH, normal T3/4
    Rising TSH indicates poor compliance
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6
Q

What biochemical changes would you see in different types of Hyperthyroidism?

A
  1. Primary= Low TSH, high T3/4
  2. Secondary = High TSH, T3/4
  3. Treated / subclinical = low TSH, normal T3/4
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7
Q

Presentation of congenital hypothyroidism

A

D5 Guthrie. Sx 6-12w
Protruding tongue
Hoarse cry
Delayed growth and development
Pale
Prolonged jaundice
Umbilical hernia

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8
Q

Congenital hypothyroidism cauases

A

Maternal iodine def.
Thyroid agenesis
Inborn error thyroid hormone synthesis
Pituitary dysfunction

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9
Q

Presentation of acquired hypothyroidism

A

Weigh gain / short
Thin skin / hair
Cold intolerance
Poor conc. / LD
Bradycardia
Goitre eg AI/ Hashimoto’s
Constipation
Low iodine

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10
Q

Presentation acquired hyperthyroidism

A

Weight loss, tall
Tachycardia
Diarrhoea
Reduced Conc.
Goitre
Eyes - Exophthalmos, opthalmoplegia, lid retraction, lid lag
Pre-tibial myxoedema

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11
Q

Causes of acquired hyperthyroidism

A

Mainly primary. More girls.
Graves’ - AI thyroiditis. TRAB Ab
Thyroiditis
Thyroid nodules
De Quervain’s thyroiditis - post-viral. Painful. Self-limiting.

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12
Q

Treatment for acquired hyperthyroidism

A
  1. Carbimazole - block thyroxine synthesis (SE neutropenia)
  2. ?2nd course
  3. Radical - thyroidectomy, radioactive iodine
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13
Q

Symptoms of hypocalcaemia

A

Tetany
Cramps
Paraesthesia
Stridor
Diarrhoea
Seizures

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14
Q

Biochemistry in hypoparathyroidism

A

Low PTH
Low Calcium
High Phosphate
Normal Alk Phos

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15
Q

Causes of hypoparathyroidism

A

DiGeorge
Magnesium deficiency
Genetic mutation of calcium sensing gene
AI

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16
Q

Presentation and biochemistry of pseudohypoparathyroidism

A
  • Presentation: Short, obese, LD, SC nodules, short 4th metacarpal
  • Biochemistry: Increased PTH and Phosphate, low Calcium, normal Alk Phos
    = end organ resistance to PTH (defect in G protein signalling)
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17
Q

Symptoms of hypercalcaemia

A

Constipation
Lethargy
Polyuria
Anorexia
Polydipsia

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18
Q

Causes of hyperparathyroidism in children?

A

Rare
William’s
Later - adenoma, MEN

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19
Q

What hormones are affected in adrenal insufficiency?

A

LOW CORTISOL
LOW ALDOSTERONE

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20
Q

Causes adrenal insufficiency

A

AI - Addison’s
CAH
Haemorrhage / infarct
Infective - TB
X-linked adrenoleukodystrophy
Removal of long term steroids (Low ACTH / CRH)

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21
Q

Presentation of adrenal insufficiency

A

LOW SODIUM, HIGH POTASSIUM
Weight loss
Abdo pain / vomiting/ dehydration
Lethargy
Pigmentation
Infant - salt losing crisis
Crisis - Low BP, low GCS, N+V

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22
Q

What tests for adrenal insufficiency?

A

Short Synacthen test
ACTH stimulation

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23
Q

Treatment for adrenal insufficiency

A

Acute - IVT, glucose, hydrocortisone
Chronic - Hydrocortisone / fludrocortisone
Double steroids if unwell

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24
Q

Presentation of congenital adrenal hyperplasia

A

Virilisation of genitalia esp girls
Salt losing crisis
Hypoglycaemia
High 17-OHP at 72 hours

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25
Genetics of CAH
Autosomal recessive HLA on Ch 6 --> defect in enzyme for steroidogenesis
26
Presentation of adrenal excess
Short and fat + striae Prox muscle weakness/ wasting Bruising Thin skin OP Red cheeks Hirutism
27
Causes of adrenal excess (high cortisol)
- Low ACTH = Adrenal adenoma, arenal nodular hyperplasia, steroids - High ACTH = Cushing's disease, pituitary adenoma, ectopic ACTH (paraneoplastic)
28
What test would you do for adrenal excess
1. Low dose Dex suppression test --> Cushing's = no suppression 2. High dose suppression test --> Cushing's disease suppressed at 8mg, ectopic ACTH / adrenal adenoma not suppressed Undetectable ACTH = adrenal tumour
29
Presentation of phaeochromocytoma
Episodic: Headache HTN Tachycardia Flushing/ sweating
30
Causes of Phaeochromocytoma
Adrenal medullary tumour Raised adrenaline / noradrenaline Increased risk in NF1
31
Ix Phaeochromocytoma
Urine catecholamines / metanephrines Blood metanephrines CT Abdo
32
Which hormones are secreted from the anterior pituitary gland?
TSH ACTH GH Prolactin LH FSH
33
Which hormones are released from the Posterior pituitary gland?
ADH Oxytocin
34
Presentation of growth hormone deficiency
Faltering growth after 6 months of age Maxillary hypoplasia Forehead prominence
35
Test for GH deficiency
GH provocation test Random GH not useful
36
How does growth hormone cause growth?
Acts on IGF-1 at growth plate --> proliferation of chondrocytes
37
Causes of Diabetes Insipidus
1. Neurogenic = Inadequate release ADH. Idiopathic, AI, pituitary disease 2. Nephrogenic = Inadequate renal response ADH (defect vasopressin-2 reception or aquaporin-2). Drugs (lithium), CRF, post-obstructive uropathy, High glucose / Na+ / Ca2+
38
Diabetes Insipidus investigations
-Low urine osmolality, High serum Osmolality - Hypernatraemia - Water deprivation test - urine conc. <600 --> give desmopressin --> concentrates only in neurogenic. SE desmopressin = water retention --> hold when unwell. - MRI head
39
Causes of SIADH
- CNS - meningitis, encephalitis, trauma, hypoxia - Haemorrhage - Guillain-Barre - Resp - LRTI, TB - Tumours - Thymoma, lymphoma, Ewing's - Drugs
40
What is Kallmann syndrome?
Defective GnRH release from hypothalamus - Anosmia - Colour blindness - Delayed puberty
41
Presentation of pituitary apoplexy
Headache Meningism Low GCS Visual field defect Ophthalmoplegia
42
Physiological response to hypoglycaemia
Increased glucagon Increased adrenaline --> Palp, tremor, sweating, pallor
43
How is mid-parental height calculated?
(Mum+Dad)/2 --> +7 in boys - 7 in girls
44
Define Short stature
Height <2nd centile 2 SD away from mean
45
Causes of Short stature
- Familial - Constitutional delay - Iatrogenic eg steroids - Nutritional - Chronic disease (low IGF-1) - Foetal alcohol syndrome - Genetics - Russell- Silver, Turner's, Noonan's, Skeletal dysplasia, Prader-Willi, Trisomies, SHOX gene - Endocrine - thyroid, GH, cortisol
46
Causes of Tall Stature
- Nutritional - same final height - Genetic- Klinefelter's, Marfan's, Beckwith-Wiedemann, Sotos, NF - Metabolic - Homocystinuria - Endocrine - Hyperthyroid, precocious puberty, CAH, excess growth hormone
47
What is defined as precocious puberty?
Onset of puberty before - 8 years in girls - 9 years in boys
48
Causes of precocious puberty
- Gonadotrophin dependent (High LH and FSH) = Pituitary mass (bitemoporal hemianopia), brain injury. More common in girls. - Gonadotrophin independent (Low FSH and LH) - adrenal tumours, CAH
49
Investigations precocious puberty
- LHRH stiulation test - LH, FSH, testosterone / oestradiol - L wrist xray - Pelvic USS - MRI brain
50
What can be used to delay precocious puberty?
Ig Gonadotrophin dependent, can use GnRH analogues eg Leuprorelin --> decreases LH / FSH
51
Causes of delayed puberty (>13y in girls, >14y in boys)
- General - illness, malnutrition, steroids - Constitutional delay (more in boys) - Systemic causes low gonadotrophin = CF, asthma, Crohn's - HPA disorder causing low gonadotrophin eg pituitary tumour, Kallmann, hypothyroid - High FSH / LH and low androgens: Turner's, Klinefelter's, gonadal damage eg surgery, radio
52
Treatment of delayed puberty
- Girls = Oestradiol - Boys = IM testosterone
53
Genetic association of Type 1 DM
HLA D3/4
54
Which auto-antibodies are associated with T1DM?
GAD ZnT8 IA-2 T cell mediated damage to beta cells
55
Glargine mechanism of action
Molecular changes --> shifts isoelectric point --> slow release of bioactive molecules
56
Definition of severe DKA
pH <7.1 HCO3- <5
57
When is insulin started in DKA and at what dose?
1 hour after rehydration 0.05 - 0.1 units/kg/hr
58
Complication of rapid fluid correction in DKA
Cerebral oedema Headache, agitation, irritability Tx: Mannitol / hypertonic saline
59
Pathophysiology PCOS + Tx
-Excess LH --> stim ovarian androgen production and hyperinsulinaemia upregulates 17-alpha-hydroxylase + synthesises androgen precursors. -High level of uninhibited oestrogen --> endometrial hyperplasia. -Tx: OCP corrects hormonal imbalances --> suppress ovarian stimulation by suppressing release of LH / FSH.
60
What does low c-peptide levels mean?
Low endogenous production of insulin
61
Diabetic retinopathy - signs on fundoscopy
Microaneurysms ‘Dot-and-blot’ haemorrhages Venous bleeding ‘Cotton wool’ spots.
62
Management of CF related DM
-Continue high calorie diet + exercise -Start insulin and monitor blood glucose levels.

RCPCH TAS/ AKP (20 decks)

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