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1

what is hypocalcaemia

low serum calcium
2.2-2.6mmol/L

2

what can cause hypocalcaemia

hypoparathyroidism
vitamin D deficiency
diarrhoea
liver and kidney disease
PPI
blood transfusions

3

how does hypocalcaemia present

muscle twitches
seizures
fractures
poor blood clotting
ventricular tachycardia
tetany

4

what are clinical tests for hypocalcaemia

chovstek's - tap skin 1cm below zygomatic process, will cause facial twitch/spasm
trousseaus - use blood pressure band to compress arm, flexors will be activated and hand will twitch

5

what investigations should you do for hypocalcaemia

ECG
serum Ca, albumin and phosphate
PTH

6

how can you manage hypocalcaemia

oral Ca tablets
oral VD tablets if deficient
if serum Ca is below 1.9 this is an emergency
treat with IV calcium gluconate

7

what is hypoparathyroidism

when the parathyroid gland does not produce enough PTH resulting in low serum Ca

8

what causes hypoparathyroidism

thyroid/parathyroidectomy
autoimmune destruction of gland

9

how does hypoparathyroidism present

symptoms of hypocalcaemia

10

what is hypercalcaemia

increased serum calcium
3-3.5mmol/l above 3.5 is an emergency

11

what can cause hypercalcaemia

hyperparathyroidism
renal failure
acromegaly
MEN syndromes
TB
sarcoidosis

12

how does hypercalcaemia present

polyuria
nausea
vomiting
constipation
bone pain
fatigue
pancreatitis
coma
osteoporosis

13

what investigations could you do for hypercalcaemia

serum Ca, albumin, phosphate
U&Es
DEXA for osteoporosis

14

how do you treat hypercalcaemia

rehydrate with 4-6l of 0.9% saline over 4-6hrs
IV bisphosphonates
glucocorticoids
calcitonin
cinacalcet

15

what is primary hyperparathyroidism

gland makes PTH uncontrollably
high serum PTH and high Ca

16

what causes primary hyperparathyroidism

adenoma
hyperplasia of gland
carcinoma

17

how does primary hyperparathyroidism present

stones, thrones, bones, moans, psychiatric overtones
Ca kidney stones
polyuria
constipation
sore bones
muscle weakness
depression
confusion

18

how can you manage hyperparathyroidism

remove tumour

19

what is secondary hyperparathyroidism

when renal failure or VD deficiency causes low absorption of Ca resulting in hypocalcaemia
the parathyroid gland reacts to this by releasing more PTH and undergoes hyperplasia
serum calcium is normal but PTH is high

20

what can cause secondary hyperparathyroidism

vitamin D deficiency
chronic kidney failure

21

how does secondary hyperparathyroidism present

symptoms of chronic renal failure
calcification of vessels

22

how can you manage secondary parathyroidism

correct VD deficiency
manage renal failure

23

what is tertiary hyperparathyroidism

when secondary hyperparathyroidism becomes primary over a long period of time
treat by surgical removal of part of the gland

24

what is primary adrenal insufficiency

hyposecretion of adrenal hormones
most commonly aldosterone and cortisol, can be sex steroids too

25

what can cause primary adrenal insufficiency

waterhouse-friederschein disease
(sudden increase in BP causing rupture of vessels causing ischaemia)

26

how does primary adrenal insufficiency present

hypotension
nausea
vomiting
confusion coma

27

what is Addison's disease

chronic primary renal insufficiency due to destruction of adrenal cortex

28

how does addison's disease present

lethargy
sore muscles, abdomen, joints
depression
diarrhoea
vomiting

29

what can cause addison's

autoimmune destruction
TB
metastatic carcinoma

30

what investigations would you do in addison's

synacthen test

31

what are clinical signs of addison's

hyperpigmentation (CRH is a precursor of melalin) - of buccal membrane, palmar creases
acanthesis nigricans
postural hypotension
weight loss

32

how can you manage addisons

hydrocortisone
fludrocortisone
increase dose when patient has infection or minor surgery
patient given emergency ID tag

33

what is addisonian crisis

sudden increased need for hormones causes acute symptoms

34

what can cause addionian crisis

sudden stopping of steroids/hormone therapy
bilateral adrenal haemorrhage

35

how does addisionian crisis present

hypotension
nausea, vomiting
pain in back abdomen and legs
dehydration
weakness
psychosis
coma

36

what investigations could you do in addisonian crisis

bloods for cortisol and ACTH

37

how could you manage addisonian crisis

Hydrocortisone Sodium succinate 100mg IV
IV saline
monitor BG
find underlying cause

38

what is graves disease

autoimmune disease where antibodies are formed that mimic TSH and bind to receptors causing an increase in T3 and T4
TRH and TSH levels are low
the increased demand for TH causes hyperplasia (increased number of follicular cells) and hypertrophy of the gland
the antibodies also stimulate fibroblasts in eyes and skin causing them to make more glycosaminoglycans
causes hyperthyroidism

39

what is toxic multinodular goitre

nodules develop on the gland that act independently of the TRH and TSH negative feedback and produce lots of TH (some TSH receptors are turned on constantly - like megan)
causes hyperthyroidism
usually caused by iodide deficiency - hypothalamus increases TRH and therefor TRH causing hypertrophy and hyperplasia of the gland - goitre develops

40

what is the effect of a thyroid adenoma

the adenoma produces TH regardless of TH level in the blood

41

what can happen when the thyroid gland is inflamed or damaged?

the hormones can all spill out causing hyperthyroidism

42

how does hyperthyroidism present

increased basal metabolic rate
heat intolerance
sweating
fever
anxiety
muscle weakness
osteoporosis if chronic
loose stools
hyperreflexia
palpitations

43

what is thyroid storm/ thyrotoxic crisis

severe hypermetabolism
life threatening

44

what can cause thyrotoxic crisis

sudden stopping of therapy
infection
surgery

45

how does thyrotoxic crisis present

pyrexia
tachycardia
delirium
arrhythmia

46

what are specific clinical signs of graves disease

enlarged thyroid - goitre
exophthalmos (bulging of eye)
pretibial myxoedema
oedema

47

what are specific clinical signs of toxic multinodular goitre

enlarged thyroid
hoarse voice
airway obstruction
dysphagia
SVC syndrome - facial and arm swelling

48

how can you treat hyperthyroidism

Carbimazole - 1st line
propylthiouracil
radioactive iodine ablation (+ levothyroxine if needed)
beta blockers
surgical removal
for thyroid storm - beta blockers, thionamides, glucocorticoids

49

what investigations can you do in hyperthyroidism

TFTs
ECG

50

what is primary hypothyroidism

thyroid gland doesn't make enough hormones

51

what can cause primary hypothyroidism

hashimoto's thyroiditis - autoimmune destruction of thyroid gland
iatrogenic - thyroidectomy or iodine ablation
chronic iodine deficiency
congenital

52

what is secondary hypothyroidism and what can cause it

there is not enough TSH to release TH
tumour of pituitary or hypothalamus

53

how does hypothyroidism present

weight gain
loss of appetite
cold intolerance
lethargy
constipation
myxoedema - swelling of tongue and skin

54

what is myxoedema coma and how does it present

extreme hypothyroidism due to surgery, infection
hypothermia
loss of consciousness
confusion

55

what investigations could you do in hypothyroidism

blood hormone levels - TH will always be low, TSH only raised in primary disease (and low in secondary disease).
thyroid peroxidase antibodies for autoimmune disease

56

how do you treat hypothyroidism

levothyroxine long term - start with a high dose and gradually reduce
TFTs every month

57

what is acromegaly

extra GH after growth plates have closed

58

what is gigantism

excess GH in kids before growth plates have closed

59

what can cause acromegaly

pituitary adenoma secreting GH
MEN 1 syndrome

60

how does acromegaly present

large hands and feet
large jaw
gaps between teeth
large forehead
soft tissue swelling
large tongue
carpal tunnel syndrome
diabetes (GH increases insulin resistance)

61

what investigations could you do in acromegaly

blood GH levels
MRI for pituitary adenoma
GH suppression test
oral glucose tolerance test

62

how do you treat acromegaly

somatostatin analogues
GH receptor antagonists
dopamine agonists
pituitary tumour removal
removal of any other causative tumour

63

what is hyperprolactinemia

high levels of prolactin in the blood

64

what can cause hyperprolactinemia

prolactinoma
pregnancy
polycystic ovary disease
tumour in hypothalamus secreting prolactin releasing hormone or in pituitary secreting prolactin
lactation
stress
dopamine depleting drugs

65

how can hyperprolactinaemia present in women

menstrual irregularity
lactating when not pregnant
infertility

66

how can hyperprolactinaemia present in men

gynecomastia
impotence
visual disturbances
headache
decreased facial hair

67

what investigations could you do in hyperprolactinaemia

blood prolactin level > 550mu/l
pregnancy and polycystic ovary test

68

how can you treat hyperprolactinaemia

dopamine agonists
increase calcium and vitamin D uptake because risk of osteoporosis

69

What is the first presentation of thyroid cancer?

A solitary hard painless lump on the thyroid gland. it can cause hoarseness and trouble swallowing if it gets too big.

70

what does non functional thyroid cancer mean?

They don't produce signs of hyperthyroidism or hypothyroidism.

71

What is the diagnosis of thyroid cancer made with?

Thyroid ultrasound. Radioiodine scan - where radio iodine is injected and taken up by cells which make thyroid hormone, usually thyroid tumours don't make thyroid hormone so they are 'cold nodues'

72

what is the definitive diagnostic test for thyroid cancer?

Fine needle aspiration.

73

what is the treatment for thyroid cancer?

partial or total thyroidectomy followed by thyroid hormone replacement.

74

what is primmery hyperaldosteronism?

aldosterone s a mineralocirtocoid. it increases sodium reabsorption, and increases hydrogen secretion and potassium secretion.

Conns syndrome - when the adrenal gland produces too much aldosterone, the renin is low because of the high blood pressure entering the kidneys.

75

Where does stage 2 of the RAAS system occur? (mediated by ACE hormones)

In the lungs.

76

which hormone stimulates the release of aldosterone?

Angiotensin II

77

what is the cause of Conns syndrome?

adrenal adenoma - most common cause.
bilateral adrenal hyperplasia
familial hyperaldosteronism.
adrenal carcinoma

78

What is secondary hyperaldosteronism?

where renin is causing the increase in aldosterone - renin will be high.

79

what is the main cause of secondary hyperaldosteronism?

when theres reduced blood flow to the kidneys, tricking them into thinking the blood pressure is too low:
renal artery stenosis, heart failure, atherosclerosis.

80

what is the investigation for hyperaldosteronism?

to check the renin:aldosterone ratio
- high aldosterone : low renin (primary hyperaldosteronism)
- High aldosterone : high renin (secondary hyperaldosteronism).

Blood pressure, hypokalaemia, alkalosis.

81

treatment of aldosteronism?

aldosterone antagonists - spironolactone, eplenerone.
surgery - remove adenoma.
percutaneous angioplasty - to stent the renal artery.

82

what does hyperaldosteronism cause?

it is the leading cause of secondary hypertension.

83

when is radioactive iodine for hyperthyroidism contraindicated?

pregnant women (can't get pregnant within 6 months)
can be around pregnant women or children for 3 weeks
must have limited contact with anyone for days after receiving the dose.

84

which mood stabilising drug can cause hypothyroidism?

Lithium - inhibits production of thyroid hormone.