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Phase 2- Gen Med > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

What is acromegaly?

A

Excessive secretion of growth hormone in patients who have passed puberty

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2
Q

What is the condition called when there is excess growth hormone in children?

A

Gigantism

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3
Q

Where is GH secreted from?

A

Anterior pituitary

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4
Q

What regulates GH secretion?

A

Growth hormone releasing hormone (GHRH)

Somatostatin (inhibits GH)

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5
Q

Where is GH releasing hormone secreted from?

A

Hypothalamus

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6
Q

What is the function of GH?

A

Indirectly stimulating soft tissue and bone growth through the use of insulin-like growth factor 1 (IGF-1)

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7
Q

What is the main cause of acromegaly?

A

Pituitary tumour

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8
Q

What are the symptoms of acromegaly?

A 
Sweating
Headaches
Increasing size of hands and feet
Amenorrhea
Infertility 
Muscle weakness
Enlarged tongue 
Increased dental spacing 
Hoarse voice
Prominent lower jaw
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9
Q

What test is done to diagnose acromegaly?

A

Oral glucose tolerance test
Glucose should inhibit GH secretion so after glucose GH levels should be undetectable. In acromegaly there is a failure to suppress GH.

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10
Q

What is the first line treatment of acromegaly?

A

Surgical removal of pituitary tumour

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11
Q

What nonsurgical treatments can be given to treat acromegaly?

A

Somatostatin analogues

Radiotherapy

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12
Q

Give 3 potential complications of acromegaly

A 
Bitemporal hemianopia
Carpal tunnel 
Diabetes 
Hypertension 
Osteoporosis 
Obstructive sleep apnea
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13
Q

What is Cushing’s Syndrome?

A

Excess cortisol in the blood

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14
Q

What is the main cause of Cushing’s syndrome?

A

Too much steroid medication (iatrogenic)

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15
Q

What is Cushing’s disease?

A

Excess cortisol due to a pituitary adenoma releasing excess ACTH.

ACTH dependent

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16
Q

Name the 3 sources that may cause excess cortisol in the body

A

Pituitary tumour
Adrenal tumour
ACTH-secreting Ectopic tumour

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17
Q

Which 4 cancers can ectopically secrete ACTH?

A

Small cell lung tumour
Thymus gland tumours
Islet cell tumours of the pancreas
Medullary carcinoma of the thyroid

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18
Q

Give 5 symptoms of Cushing’s

A 
Weight gain centrally 
Depression 
Insomnia 
Amenorrhea
Thin skin 
Easy bruising 
Stretch marks 
Acne 
Back pain 
Excessive hair growth (women) 
Polyuria
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19
Q

Give 5 signs of Cushing’s

A 
Moon face
Osteoporosis 
Proximal myopathy
Increased pigmentation 
Kyphosis
Buffalo hump 
Oedema
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20
Q

Why may a woman with Cushings have signs of hirsutism?

A

Excess ACTH stimulates excess testosterone to be released from the adrenal glands as well as excess cortisol

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21
Q

What condition is very commonly associated with Cushing’s?

A

Type II diabetes

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22
Q

How does the dexamethasone suppression test diagnose Cushing’s?

A

Give the patient a dexamethasone tablet. Dexamethasone should suppress ACTH release from the pituitary. The following morning test serum cortisol levels. If cortisol is still high then Cushing’s disease is diagnosed

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23
Q

How can the cause of Cushing’s be established from the dexamethasone suppression test?

A

Pituitary tumour –> at low dose high cortisol, high ACTH. At high dose, decreased cortisol

Ectopic tumour –> at low dose high cortisol, high ACTH. At high dose, high cortisol

Adrenal tumour –> at low dose high cortisol, low ACTH

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24
Q

Why are stand alone cortisol readings unrepresentative of Cushing’s disease?

A

Cortisol levels are cyclical and so readings cannot be compared against a standard.

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25
Q

How is Cushing’s disease treated?

A

Surgical removal of the tumour

Decrease steroid medication

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26
Q

What is Primary Hypoadrenalism (Addison’s disease)?

A

Destruction of the adrenal cortex which results in a lack of secretion of cortisol, aldosterone and the sex hormones

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27
Q

What are the two main causes of Addison’s?

A

Autoimmune reaction

TB infection

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28
Q

Give 5 symptoms of Addison’s disease

A 
Fatigue 
Weight loss
Anorexia
Myalgia
Dizziness
Fainting 
Low self esteem
Depression 
Skin pigmentation
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29
Q

What happens to sodium levels in Addison’s?

A

Decrease

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30
Q

What is an Addisonian crisis?

A

Severe hypotension and dehydration following trauma or an illness.

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31
Q

How is an Addisonian crisis treated?

A

Emergency cortisol

Sodium infusion

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32
Q

What tests can be done to help diagnose Addison’s disease?

A

U&Es, glucose, adrenal antibodies, FBC, Serum aldosterone, chest and abdo x-ray

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33
Q

Describe the ACTH stimulation test

A

Given synthetic ACTH to stimulate cortisol production. Cortisol should rise rapidly to >550 nmol/L but in Addison’s it will not

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34
Q

How is Addison’s managed in the long term?

A

Oral hydrocortisone
Monitor BP and serum electrolytes and weight
Educate patient on effects of long-term steroid use

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35
Q

When does secondary hypoadrenalism occur?

A

Secondary hypoadrenalism occurs when a patient has been taking long-term steroids and they suddenly stop them. The HPA axis has been suppressed due to the ectopic source of cortisol so when the patient suddenly stops the body cannot quickly adjust to making enough cortisol on its own.

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36
Q

In secondary hypoadrenalism, why is aldosterone secretion not affected?

A

Stimulation from angiotensin II

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37
Q

What happens to the aldosterone level in primary and secondary hypoaldosteronism?

A 
Primary = high 
Secondary = low
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38
Q

How is secondary hypoaldosteronism treated?

A

Restart steroids and gradually reduce rather than come off in one go
If pituitary disease, can give synthetic ACTH

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39
Q

What is hyperthyroidism?

A

Excess thyroid hormone in the blood.

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40
Q

What is the epidemiology of hyperthyroidism?

A

Women more affected

Ages 20 to 40

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41
Q

What is Grave’s disease?

A

Autoimmune condition where antibodies are produced for the TSH receptor which stimulate more TSH to be produced. The TSH then creates more T3 and T4.

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42
Q

What are the two most common causes of nodular thyroid disease?

A

Iodine excess in the diet

Medications such as Amiodarone

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43
Q

Give 5 symptoms of hyperthyroidism

A 
Weight loss 
Hyperactivity 
Palpitations 
Fatigue 
Weakness
Diarrhoea
Polyuria 
Menorrhagia 
Fine tremor
Intolerance to warmth 
Gynaecomastia
Proptosis
Clubbing 
Goitre
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44
Q

What is a thyrotoxic storm?

A

Undertreated hyperthyroidism

Fever, seizures, vomiting, diarrhoea, jaundice, arrhythmias, heart failure, hyperthermia

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45
Q

How is a thyroid storm treated?

A

Propranolol
Antithyroid drugs
Potassium iodide
Corticosteroids

46
Q

How is hyperthyroidism treated?

A

Propranolol (symptom control)
Radioiodine
Carbimazole (risk of agranulocytosis)

47
Q

What is hypothyroidism?

A

Thyroid does not produce enough thyroid hormone

48
Q

Give 3 ways hypothyroidism can occur

A

Autoimmune destruction
Excessive treatment of hyperthyroidism
Iodine deficiency

49
Q

What is atrophic hypothyroidism?

A

T-cell mediated cytotoxicity against follicular cells in the thyroid

50
Q

What is hashimoto’s disease?

A

Thyroid attacked by T-cells which causes a goitre to form due to infiltration of the thyroid with lymphocytes resulting in fibrosis.

51
Q

What are the symptoms of hypothyroidism?

A 
Tiredness
Weight gain 
Cold intolerance
Poor appetite
Depression 
Thin hair 
Constipation 
Dry skin 
Hypertension 
Hypothermia 
Bradycardia
52
Q

What investigations will be done for hypothyroidism?

A 
FBC
U&Es
Cholesterol 
TSH 
T3/4
53
Q

How is hypothyroidism treated?

A

Levothyroxine

54
Q

What is Conn’s Syndrome?

A

Type of primary hyperaldosteronism from an aldosterone-producing adenoma

55
Q

What are the symptoms of Conn’s syndrome?

A

Often asymptomatic

Can have weakness, cramps, polyuria, polydipsia

56
Q

How is Conn’s syndrome treated?

A

Laparoscopic adrenalectomy

Spironolactone

57
Q

What is diabetes insipidus?

A

Reduced ADH secretion from the posterior pituitary causing the passage of large amounts of dilute urine.

58
Q

What happens to sodium and potassium levels in diabetes insipidus?

A

Hypokalaemia

Hypernatraemia

59
Q

What are the symptoms of diabetes insipidus?

A

Polyuria
Polydipsia
Dehydration
Symptoms of hypokalaemia and hypernatraemia

60
Q

What are the causes of a lack of ADH production?

A 
Hypothalamus disease
Pituitary disorder
Neurosurgery
Trauma 
Idiopathic 
Sarcoidosis
61
Q

How is diabetes insipidus treated?

A

Identify and treat the cause

Give desmopressin which is synthetic ADH

62
Q

What is SIADH?

A

Excessive ADH secretion from the posterior pituitary gland or another ectopic source.

63
Q

Why does SIADH result in hyponatremia?

A

The level of sodium in the blood stays the same but because the blood fluid increases there is a dilutional hyponatraemia

64
Q

What is the pathophysiology of SIADH?

A

ADH acts on the DCT and collecting duct to reabsorb water and dilute the blood. When ADH secretion is not suppressed excessive water is reabsorbed back into the blood

65
Q

Give 5 potential causes of SIADH

A 
Small cell lung tumour 
Meningitis 
Head injury 
TB 
Alcohol withdrawal 
Opiates 
Hypothyroidism
66
Q

What are the clinical features of SIADH?

A 
Nausea
Myalgia
Irritability 
Headache 
Cheyne-Stokes respiration
67
Q

What is Cheyne-Stokes respiration?

A

Repeating cycles of deep and fast breathing followed by apnoea

68
Q

How is SIADH diagnosed?

A

Euvolemic hyponatremia
Low serum sodium
High urine sodium
Low plasma osmolality
Absence of hypokalemia, hypotension and hypovolemia
Normal renal, adrenal and thyroid function

69
Q

How is SIADH treated?

A

Treat underlying cause
Water restriction
Demeclocycline (inhibits action of ADH)
Tolvaptan (treats hyponatremia)

70
Q

What is a microadenoma?

A

Pituitary tumour which is <1 cm across

71
Q

What is a macroadenoma?

A

Pituitary tumour which is >1 cm across

72
Q

What are the 3 histological types of pituitary tumour?

A

Chromophobe –> mostly non-secreting
Acidophil –> secrete GH or prolactin
Basophil –> secrete ACTH

73
Q

What are the symptoms from a pituitary tumour?

A

Caused by raised intracranial pressure or from the abnormal pituitary secretions

Headaches, visual field defects, anopia, CN III, IV, VI palsy

74
Q

What investigations are done if a pituitary tumour is suspected?

A

LH, FSH, Testosterone, TSH, T4, Prolactin, IGF-1, cortisol, U&Es, FBC, short synACTHen test, insulin tolerance test, MRI of pituitary

75
Q

How is a pituitary tumour treated?

A

Hormone replacement
Transsphenoidal surgery to remove tumour
Radiotherapy

76
Q

What is hypopituitarism?

A

Reduced secretion of pituitary hormones

77
Q

In which order are pituitary hormones affected in hypopituitarism?

A

GH –> FSH –> LH –> prolactin –> TSH –> ACTH

78
Q

Why may panhypopituitarism occur?

A

Irradiation
Surgery
Large tumour

79
Q

In what situations will oxytocin and vasopressin be affected in hypopituitarism?

A

If the hypothalamus is affected as well

80
Q

Give 3 hypothalamic causes of hypopituitarism

A 
Kallmann's syndrome
Tumour 
Inflammation 
Infection (TB/meningitis) 
Ischaemia
81
Q

Give 3 pituitary stalk causes of hypopituitarism

A 
Trauma 
Surgery 
Mass lesion 
Meningioma 
Carotid artery aneurysm
82
Q

Give 3 pituitary causes of hypopituitarism

A 
Tumour 
Irradiation 
Autoimmunity 
Inflammation 
Infiltration 
Ischaemia
83
Q

How is hypopituitarism treated?

A 
Oral replacement of steroids and thyroid hormones
LH and FSH analogues 
Testogel to replace testosterone 
Oestrogen if premenopausal 
GH therapy in children
84
Q

What is the main cause of primary hyperparathyroidism?

A

Adenoma of the parathyroid gland

85
Q

How does hyperparathyroidism present?

A

Weakness, depression, tiredness, thirst, abdominal pain, bone pain, fractures

86
Q

How is hyperparathyroidism diagnosed?

A 
Serum calcium 
Serum PTH 
Phosphate 
LFTs
X-ray
DEXA scan for osteoporosis
87
Q

How is hyperparathyroidism managed?

A

Increase fluid intake
Avoid thiazide diuretics
Remove tumour

88
Q

What is the main cause of secondary hyperparathyroidism?

A

Chronic renal failure

Vitamin D deficiency

89
Q

What 3 cancers can ectopically secrete parathyroid hormone?

A

Squamous cell lung tumour
Breast cancer
Renal cell carcinoma

90
Q

What are the main causes of hypoparathyroidism?

A

Autoimmune destruction

DiGeorge syndrome

91
Q

How is hypoparathyroidism treated?

A

Ca2+ supplements
Calcitriol
Synthetic PTH

92
Q

How is hypoparathyroidism diagnosed?

A

Serum PTH
Calcium
Phosphate
LFTs

93
Q

What is hyperprolactinemia?

A

Excess prolactin present in the blood

94
Q

Give 4 reasons for hyperprolactinaemia

A

Pregnancy (physiological)
Pituitary prolactinoma
Pituitary stalk compression (causing reduced dopamine)
Drugs- metoclopramide, haloperidol, oestrogens

95
Q

What are the symptoms of hyperprolactinemia?

A

Amenorrhoea, infertility, galactorrhea, weight gain, loss of libido, erectile dysfunction, loss of facial hair

96
Q

How is hyperprolactinemia treated?

A 
Dopamine agonists (bromocriptine)
Removal of tumour
97
Q

What is pheochromocytoma?

A

Neuroendocrine tumour of the medulla of the adrenal glands which secretes large amounts of noradrenaline and adrenaline

98
Q

How does pheochromocytoma present?

A 
Headaches
Hypertension 
Tachyarrhythmias
Flushing 
Weight loss
Malaise
Sweating 
Pallor
Hyperglycaemia 
Pyrexia
Abdominal pain
99
Q

Give 4 complications of pheochromocytoma

A 
MI 
Heart failure 
Cardiomyopathy 
Arrhythmias
Stroke 
Coma 
Death
100
Q

How is pheochromocytoma diagnosed?

A

Metadrenaline levels
24hr urine collection of catecholamines
CT abdomen

101
Q

How is pheochromocytoma treated?

A

Alpha-blockers
Beta-blockers
Surgical resection of adrenal gland

102
Q

What is the karyotype in Turner’s patients?

A

(45,X)

103
Q

What are the features of Turner’s syndrome?

A

Short, underdeveloped ovaries, lack of periods, infertility, webbed neck, low hairline, spoon-shaped nails

104
Q

Name 3 conditions Turner’s syndrome is associated with

A 
Heart murmurs
UTIs
Hypothyroidism 
Hypertension 
Osteoporosis
Scoliosis 
Diabetes
Crohn's 
UC
105
Q

What is the karyotype in Klinefelter’s patients?

A

(47,XXY)

106
Q

What are the features of Klinefelter’s syndrome?

A

Tall, lack of secondary sexual characteristics, small testes, infertile, gynaecomastia, elevated gonadotropin levels

107
Q

What is Multiple Endocrine Neoplasia (MEN)?

A

The occurrence of several functional tumours in multiple endocrine glands. The glands involved all have a similar embryological origin.

108
Q

What are the features of MEN Type 1?

A

Presents in 30-50s
Parathyroid hyperplasia
Pancreatic tumours
Anterior pituitary tumours (prolactinoma or acromegaly)

May also get carcinoid syndrome (flushing, diarrhoea, palpitations, hypotension and right sided heart failure)

109
Q

What are the features of MEN Type 2a?

A

Medullary thyroid carcinoma
Adrenal pheochromocytoma (bilateral)
Parathyroid hyperplasia

110
Q

What are the features of MEN Type 2b?

A

Medullary thyroid carcinoma
Adrenal pheochromocytoma (bilateral)
Hyperplasia of autonomic ganglia in the intestinal wall
Mucosal neuromas on lips, cheek, tongue and glottis

111
Q

How is MEN managed?

A

Removal of the tumours surgically
Treatment of symptoms as they present
Screen family members due to autosomal dominant inheritance
Ongoing surveillance to detect new tumours early

Phase 2- Gen Med (7 decks)

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