Week 128 General Endocrine Flashcards
(86 cards)
Describe the signs and symptoms of Hypoadrenalism (adrenal insufficiency)
Profound Hypotension (especially postural) Vomiting Diarrhoea Abdo pain/salt craving Increased skin pigmentation
Describe the signs and symptoms of Cushing’s syndrome.
Prolonged and inappropriate elevation of free corticosteroid levels.
Central Obesity & Moon Face, Plethora & Acne, menstrual Irregularity
Hirsutism, Hypertension, Diabetes,
Muscle wasting and weakness
Osteoporosis
What are the initial investigations of Cushing’s syndrome?
Full Blood count, U&E, LFT, Bone profile Thyroid stimulating hormone Urinary free cortisol Low dose dexamethasone suppression test (Initial screen is positive if cushings)
Describe the investigations you would use for a patient with Addison’s disease.
ACTH = < Free cortisol = > ACTH stimulation Test (Failure to rise) U&E: >Na+, normal or < K+, < Urea < Plasma renin & >Aldosterone
Whats is a rare cause of Addison’s often coming up in an EMQ?
Haemochromatosis
List common causes of Hypercalcaemia.
Primary Hyperparathyroidism (proliferation of cells secreting parathyroid hormone) accounts for about 90% of cases.
Malignancy 30-70% in hospital.
Excess vitamin D may cause Hypercalcaemia.
List the common causes of Hypocalcaemia.
Hypocalcaemia with high PTH = Chronic kidney disease (reduced hydroxylation of 25-hydroxy-vitamin D; Vitamin D Deficiency (decreased 25-hydroxylation in the liver)
Hypocalcaemia with low PTH = Hypoparathyroidism after neck surgery, acute pancreatitis, severe hypomagnesia, sepsis/major illness.
What happens to PTH and CA2+ in primary hyperparathyroidism?
Elevated both.
What happens to serum PTH and CA2+ in secondary hyperparathyroidism?
Increased PTH
Normal or LOW serum calcium
Describe the initial investigations you would conduct for a patient with hypercalcaemia.
Serum calcium - corrected for serum albumin
Above 2.65 mmol/L
ECG - look for shortened QT intervals,
Describe the initial investigations of a patient with hypocalcaemia.
Calcium (adjusted for albumin) Serum PTH (low = check magnesium) (high = check urea/creatnine) Magnesium = low = magnesium deficiency Urea/Creatinine = High = renal failure Vitamin D = Low = Vitamin D deficiency
What are the clinical signs of hyperparathyroidism?
Renal Stones Corneal calcification Muscle weakness Tiredness Polydypsia/Polyuria
What is the most common cause
of hypothyroidism?
Hasimoto’s throiditis
Autoimmune
F:M 12:1
What are the common causes of male Primary hypogonadism?
Androgen deficiency.
Klinefelter’s syndrome.
Surgical castration or trauma
Infections - orchitis ; age ; Chronic liver and kidney disease
Drugs, alcohol, chemotherapy, radiotherapy; androgen resistance
Name the typical causes of secondary hypogonadism in men.
Constitutional delayed puberty
CUSHINGS SYNDROME
drugs, opiates, anabolic steroids
Chronic disease, liver, kidney, HIV, diabetes
Ageing; obesity; Hypopituitarism; Hyperprolactinaemia
Clinical signs of Klinefelter’s?
Small firm testes
Gynaecomastia, eunuchoid
Infertile, hyalinised seminiferous tubules
Elevated gonadotrophin and low testosterone levels
Two or more X chromosomes; learning disabilities
Clinical symptoms of Kallmann’s syndrome (2ndary Hypogonadism)
Low testosterone
Abscent facial hair, infertility, gynaecomastia, poor musculature.
Pubertal deficiency, eunochoid body proportions span 5cm >height
Bilateral small testis
Anosmia, colour blindness
What are the causes of Gynaecomastia?
Deficient testosterone sythesis
< oestrogen production
Drug induced
What is a typical cause of gonadal dysfunction in women?
Drugs
Noonan’s syndrome (46xx)
Turners Syndrome (45XO)
Disorders of hypothalamo-pituitary function or hyperprolactinaemia
Ovarian dysfunction, <androgen production (PCOS and Adr.Hyperpla.)
Describe symptoms and signs of hypogonadism in men AND women
Amenhorrea/Weight loss Gynaecomastia/Hirsuiitism/Small hard testis Infertility Poor muculature Span <5cm than height
Describe initial investigations of Hypogonadism in men and women.
Testosterone, LH, FSH, Free T4, TSH, U&Es, LFTs
Prolactin
Oestradiol, Gnrh (gonadotrophin regulating hormone)
How do you differentiate primary from secondary hypogonadism?
Morning LH and FSH.
Testosterone
PRIMARY = >Testosterone, High/normal FSH & LH
SECONDARY = Low testosterone, high normal to high levels of LH and FSH.
You can use testosterone replacement therapy to treat WHICH clinical signs?
Loss of libido, erectile dysfunction, diminished intellect, depression
Lethargy, osteoporosis, loss of secondary sexual characteristics, loss of muscle and strength
Causes of PRIMARY Hypogonadism?
Noonan syndrome, Turner syndrome, Klinefelter syndrome, XY females with SRY gene immunity.
