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Year 3 Junior Medsurg > Endocrinology & Metabolism > Flashcards

Endocrinology & Metabolism Flashcards

1
Q

Where is TRH released from and what does it stimulate?

A

TRH is released from the hypothalamus and stimulated the release of TSH from the anterior pituitary gland

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2
Q

What is the definition of thyrotoxicosis?

A

Thyrotoxicosis is the clinical effect of excess thyroid hormone

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3
Q

What are the symptoms of thyrotoxicosis?

A

Diarrhoea, weight loss, increased appetite, over-active, sweats, heat intolerance, palpitations, tremor, irritability, labile emotions, oligomenorrhoea.

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4
Q

What are the signs of thyrotoxicosis?

A
  • Pulse fast/irregular (AF/SVT)
  • Warm moist skin
  • Fine tremor
  • Palmar erythema
  • Thin hair
  • Lid lag
  • Lid retraction

There may be goitre, thyroid nodules or bruit depending on the cause

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5
Q

Name the three signs of Grave’s disease

A

1) Eye disease: exopthalmos and opthalmoplegia
2) Pretibial myxoedema (oedematous swellings on the shins)
3) Thyroid acropachy (extreme manifestation with clubbing, painful finger and toe swelling and periosteal reaction in the limb bones).

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6
Q

What happens to the TSH and T4 levels in hypOthyroidism?

A

TSH is increased, T4 is decreased

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7
Q

What happens to the TSH and T4 levels in hypErthyroidism?

A

TSH is decreased, T4 is increased

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8
Q

What is the definition of myxoedema?

A

Myxoedema is the clinical effect of a lack of thyroid hormone.

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9
Q

Name an anti-thyroid medication

A

Carbimazole

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10
Q

Whats the difference between Cushings syndrome and Cushings disease

A
  • Cushing’s syndrome describes the clinical effect of prolonged exposure to elevated levels of glucocorticoids.
  • Cushing’s disease is an ACTH releasing pituitary adenoma
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11
Q

What is the chief cause of Cushings syndrome?

A

Oral steroids

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12
Q

Endogenous causes of Cushing’s syndrome are rare, however, of these endogenous causes, what % is due to Cushings disease? i.e. a pituitary adenoma

A

80%

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13
Q

Whats the commonest cause of ectopic adrenocorticotropin hormone (ACTH) production?

A

Small cell lung cancer

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14
Q

The mnemonic “those pituitaries are fun little glands” helps to remember the main hormones secreted from the anterior pituitary gland. Name these hormones.

A 
T= TSH
P= Prolactin
A= ACTH
F= FSH
L= LH
G= Growth hormone
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15
Q

What are the other two hormones secreted by the anterior pituitary gland not included in the mnemonic?

A

Melanocyte stimulating hormone and Beta-endorphin

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16
Q

What two hormones are released from the posterior pituitary gland?

A

Oxytocin and ADH

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17
Q

Anybody presenting with symptoms of endocrine and visual disturbance should alert you to the possibility of what?

A

A pituitary tumour pressing on the optic chiasm

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18
Q

What dynamic test is usually used to determine the level of growth hormone? Explain the procedure and results

A

GH is usually measured with an Oral Glucose Tolerance Test. Glucose and GH are measured at 30 minute intervals for 150 minutes. Insulin is released in response to the glucose and in healthy people, insulin causes suppression of GH. However, if there is no suppression or if levels of GH rise, this is diagnostic of acromegaly.

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19
Q

What baseline blood test can be done to help to give an idea of the GH levels in the previous 24 hours?

A

IGF-1. IGF-1 levels can be measured as a baseline blood test because levels of IGF-1 change much slower

20
Q

Acroparaesthesia is a symptom of acromegaly. What does acroparaesthesia mean?

A

Numbness, tingling, or other abnormal sensations in the extremities

21
Q

What are the three treatment options for acromegaly in order of use?

A

1) surgery
2) Radiotherapy
3) Lifelong suppression of growth hormone with ocreotide

22
Q

What is the commonest cause of acromegaly?

A

A pituitary somatotroph adenoma

23
Q

What is the commonest visual disturbance caused by acromegaly secondary to a pituitary tumour?

A

Bitemporal hemianopia

24
Q

Other than acroparaesthesia, what symptoms might a patient with acromegaly complain of?

A

Ammenorhoea, headache, decreased libido, sweating, snoring, arthralgia, backache

25
Q

What are the signs of acromegaly?

A

Increased growth of hands, jaw and feet, coarsening face, wide nose, big supraorbital ridges, macroglossia, spacing of the teeth, puffy lips, lids and skin, scalp folds, skin darkening.

26
Q

If you suspect Cushing’s syndrome in a patient who is found to have a raised plasma cortisol, what laboratory tests can be done to localise the source of the problem?

A

An overnight dexamethasone suppression test and a 24hr urinary free cortisol test

27
Q

Discuss the three potential tumours that could cause Cushing’s syndrome and what investigation results aid the diagnosis

A

One possibility is an adrenal adenoma or carcinoma causing hypersecretion of cortisol. This diagnosis can be confirmed by testing plasma ACTH levels. You would expect plasma ACTH levels to be suppressed to undetectable amounts due to the negative feedback.

If it’s not that, you need to distinguish between a pituitary adenoma (i.e. cushing’s disease) and an ectopic ACTH secreting tumour. This is done with a high-dose dexamethasone secretion test. If the patient has Cushing’s disease it will cause at least partial depression of cortisol levels as there will still be some negative feedback if the problem is pituitary based. If there is no suppression at all at high levels, then the source must be ectopic, such as a small cell lung cancer because these will not have feedback receptors.

28
Q

What drug can be used to lower plasma cortisol levels?

A

Metyrapone (or accept aminoglutethamide)

29
Q

How is hyperprolactinaemia usually treated?

A

By giving a dopamine agonist e.g. cabergoline or bromocriptine

30
Q

What is Sheehan’s syndrome?

A

Sheehan’s syndrome is also known as postpartum hypopituitarism. It is a rare complication of pregnancy leading to hypopituitarism caused by ischemic necrosis due to blood loss and hypovolemic shock during and after childbirth.

31
Q

What is the normal range of fasting blood glucose?

A

3.5 - 5.6

32
Q

What is somatostatin also known as? Where is it released from?

A

Growth hormone inhibiting hormone. It is released from the delta cells of the pancreas.

33
Q

Where is the GLUT 1 transporter found?

A

On the surface of beta cells

34
Q

What drugs can cause diabetes mellitus?

A

Steroids, atypical antipsychotics, thiazides and anti-HIV drugs

35
Q

Symtpoms of hyperglycaemia + raised blood glucose is diagnostic of DM. What figures are diagnostic of DM in:

a) Fasting blood glucose
b) Random blood glucose

A

a) >7.0 mmol/L

b) >11.1 mmol/L

36
Q

People with acromegaly can also get diabetes mellitus. Why?

A

Excess growth hormone counters the effects of insulin leading to insulin resistance

37
Q

What type of drug is gliclazide?

A

Sulfonylurea

38
Q

How do sulfonylureas work?

A

They increase the secretion of insulin

39
Q

How do glitazones work? give an example of a glitazone

A
  • Increase insulin sensitivity

- Peoglitazone

40
Q

Name one alpha glucosidase inhibitor

A

Acarbose (SE: diarrhorea, wind, bloating; Prevents starch > sugar breakdown)

41
Q

What is the first line pharmacological treatment of type II diabetes? What is added after this if control is still not acceptable?

A

Metformin (a biguanide) is 1st line. It increases sensitivity to insulin and is a mild anorectic helping weight control.

If HbA1c is >7% 6 weeks later add a sulfonylurea e.g. gliclazide

If HbA1c >7.4% at 6 months with both those, insulin might be needed e.g. novorapid before/after meals

42
Q

What is Kallmann’s syndrome?

A

Hypogonadism + anosmia

43
Q

Name three causes of diffuse smooth goitre

A
  • Grave’s disease
  • Thyroiditis
  • Iodine deficiency

Also…
-Side effect of lithium

44
Q

What are the 3 key risk factors for diabetic retinopathy?

A

1) Duration of diabetes
2) Blood glucose
3) Hypertension

45
Q

What % of Type I diabetics develop end stage renal failure? Type II?

A

Type I 60%

Type II 20%

Year 3 Junior Medsurg (8 decks)

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