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Flashcards in Other endo 1 Deck (23):
1

What are the symptoms of high calcium?

Renal Stones
bone pain
psychic moans - depression
Groans - abdo pain, pancreatitis, Peptic ulcer disease
thrones - polyuria, polydipsia ( nephronic DI) and constipation

OTHER - high BP

2

What are the causes of primary hyperparathyroidism ?

80% solitary adenoma
20% hyperplasia
0.5 parathyroid less than 0.5 %

3

what investigations would do and what results would you see in a patient with primary hyperparathyroidism?

high CA
high or inappropriately normal PTH
high ALP
low PO4

ECG: short QT, bradycardia, 1st degree heart block

x-ray: Osteitis fibrosa cystica, phalangeal erosion

DEXA : osteoporosis

4

What is Osteitis fibrosa cystica?

It is a skeletal disorder resulting in a loss of bone mass, a weakening of the bones as their calcified supporting structures are replaced with fibrous tissue (peritrabecular fibrosis), and the formation of cyst-like brown tumors in and around the bone

5

What is the treatment for Primary hyperparathyroidism

General
increase fluids
avoid dietary CA and thiazides

surgery
The definitive management is total parathyroidectomy

conservative management may be offered if the calcium level is less than 0.25 mmol/L above the upper limit of normal AND the patient is > 50 years AND there is no evidence of end-organ damage

calcimimetic agents such as cinacalcet are sometimes used in patients who are unsuitable for surgery

6

What are the causes of secondary hyperparathyroidism ?

vitamin D deficiency
chonric renal disease

7

What is the treatment for secondary hyperparathyroidism?

correct causes
give phosphate binder
VIT D calicitriol ( active)
cinacalcet

8

What is pseudohypoparathyroidism ?

Failure of target organ response to PTH
symptoms of hypocalciumia
short 4th and 5th metacarpals, short stature
Ix low ca and high PTH

9

What is pseudoppseudohypoparathyroidism

Normal receptor in kidney and normal biochem

abnormal paternal receptors in the body

10

What are the symptoms of Cushing's

Proximal myopathy
thin skin

striae
bruising
acne and hirsutism
Moon face
Interscapular nad supraclavicular fat pads
centripetal obesity



11

What medical conditions are associated with Cushing's

HTN
osteoporosis
DM
hypokalaemia ( NA can be normal or low )

12

What are the ATCH independent causes of Cushing's syndrome?

STERIODS: commonest cause
adrenal adenoma/CA
adrenal noduar hyperplasia

(ACTH will be low due to feedback)

13

What are the ATCH-dependent cause of

Cushing disease - pityitary tumour
( corisol supression on high-dose dex)

ectopic ACTH
causes: SCLC, carninoid tumour

No suppression by any dose of dex

14

what investigations would you do for a ptx with crushing's?

1st 24 hour unrinary free cortisol
lat night serum or salivary corisol

dexamethasone suprression test
ACTH ( acth degrades very qucikly after venepunture

imaging: CT. MRI, chest x-ray

15

What is the treatment for patients with Cushing's?

cushing disease -trans-sphenoidale excision
adrenal adenoma/ca: adrenelectomy - hydrocortisone and fludrocortisone

16

What is Nelson's syndrome

rapid enlargement of pituitary adenoma following bilateral adrenalectomy for Cushing syndrome

presentation
mass effects: bitemporal heminaopia
hyperpigmentation

17

what are the features Primary hyperaldosteronism

Hypokalemia: weakness, hypotonia, hyporeflexia, cramps

High BP

paresthesia

18

what are the causes of primary hyperaldosteronism?

bilateral adrenal hyperplasia (70%)
adrenocortical adenoma ( 30%): Conn's syndrome

19

What is the treatment for Conn's ?

laparoscopic adrenalectomy

20

What is the treatment for adrenal hyperplasia?

Spironolactone, plerenone and amiloride

21

What are the investigations and results would you see in a patient with primary hyperaldosteronism?

U&Es normal or high NA, low K
aldosterone: renin ratio increased
ECG flat/ inverted T waves, U waves, depressed ST segments, pronged PR and Qt intervals

22

what is the cause of secondary hyperaldosteronism?

due to increased renin from decreased renal perfusion

causes
RAS
diurectics
CCF
hepatic failure
ephrotic syndrome

normal aldosterone:renin ratio

23

Addison's patient unwell what advice should they be given in regard to the dose of their hydrocortisone and fludrocortisone?

double the dose of hydrocortisone. keep the same does of fludrocortisone