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100 Cards in this Set
- Front
- Back
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What is the most common cause of primary hyperthyroidism? |
Graves Disease - Autoimmune disease |
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Why does graves disease cause hyperthyroidism |
IgG antibodies which over stimulate the TSH receptors on the thyroid follicular cells. Which increases TH production. |
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Name 3 clinical signs of primary hyperthyroidism (graves disease) |
1. Bulging eyes and lid lag 2. Goiter 3. Tremor |
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Name 4 symptoms of primary hyperthyroidism (graves disease) |
1. Heat intolerance and Weight loss - due to Increased metabolic rate 2. Muscle weakness due to protein catabolism from increased proteolysis 3. Elevated cardiac function - TH is permissive to epinephrine effects 4. Hyperexitable reflexes |
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What is the most common type of autoimmune cause of primary hypothyroidism? |
Hashimoto's Disease - antibodies attack the thyroid gland tissue itself |
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Name one dietary and one idiopathic cause of primary hypothyroidism |
Dietary - Iodine deficiency Idiopathic - Thyroiditis |
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Name 4 sings of hypothyroidism |
1. Goiter 2. Puffy eyes 3. 'Peaches and cream' complexion 4. Dry/thin hair and skin |
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Name 4 symptoms of primary hypothyroidism |
1. Tiredness 2. Weight gain 3. Cold intolerance - decreased metabolic rate 4. Poor labido/depression 5. Altered nervous system - slowed speech 6. Slowed cardiac rate |
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What are the 3 causes of a Goiter formation? |
Hyperthyroidism - Raised TH and low TSH Hypothyroidism - Low TH so raised TSH Euthryoidsm - enlargement with no TH change (due to raised TRH) |
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Apart from graves disease, name two other causes of primary hyperthyroidism |
Toxic multi nodular Goiter Thyroid adenoma |
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What does raised TSH levels but low T3 and T4 levels imply? |
Primary Hypothyroidism |
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What does low T3,4 levels and low TSH levels imply? |
Secondary Hypothyroidism |
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What does high T3,4 levels and low TSH levels imply? |
Primary Hyperthyroidism |
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What does high T3,4 levels and high TSH levels imply? |
Secondary Hyperthyroidism |
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What is the difference between acromegaly and giantism? |
Acromegaly caused by a pituitary tumour releasing GH after the epiphyseal plates have fused.Bones can only grow wide. Usually in middle age. Giantism is caused by a pituitary tumour releasing GH before the epiphyseal plates have fused. Bones can grown long. Occurs in childhood. |
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What is the treatment for acromegaly? |
Surgery to remove tumour + Somatostatin (GHIH) analogues |
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Name 4 clinical signs of acromegaly |
Pronounced brow Pronounced lower jaw protrusion Increased teeth spacing Carpal tunnel syndrome - pain/numbness in thumb |
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What is the cause of Laron Dwarfism? |
Peripheral tissue not responding to plasma GH levels. |
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What is the cause of Pygmies dwarfism? |
Inability in cells to produce IGF in response to GH stimulus. Caused by a genetic mutation. |
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What is Precocious puberty and why does it cause stunted growth? |
When the GnRH is released too early in life and it stimulates Oestrogen and Androgen to fuse the epiphyseal plates prematurely. |
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What are the 4 main symptoms of hypocalceamia? |
Tetany Muscle twitching Irritability Numbness |
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What are the 3 main clinical signs on examination that a patient has hypocalceamia? |
Chovstek’s sign - if you apply pressure to the facial nerve with runs over the zygomatic arch then the patients face muscles will spasm/twitch. Trousseau’s Sign - if a blood pressure cuff is applied and then tightened, the patients hand will spasm towards upwards and back - called caropedal spasm. Long QT wave on an ECG |
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Name 4 common causes of Hypocalceamia |
Hypoparathyroidism - caused by autoimmune disease, surgical/radiotherapy damage, metastasis or the embryological condition DiGeorges Syndrome Hyperventilation Vit D deficiency Drug induced = Bisphosphonates used in bone reabsorption for osteoporosis |
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If somebody has suspected hypoparathyroidism then what investigations would be carried out? |
PTH levels Serum calcium/albumin levels U&Es to check kidney function ECG Vit D levels - If PTH is high but Ca still low then probs to do with a vitD deficiency. Phosphate and magnesium levels |
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What is Pseudohypoparathyroidism a variant of, why does it cause hypocalceamia and at what stage in life does it typically present? |
Variant of Hypoprarthyroidism. Causes hypocalceamia due to lack of responsiveness from kidneys and bone to PTH and so the re-uptake of Calcium into blood stream does not occur. Mainly occurs in childhood. |
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What is the term for clinical signs which present in Pseudohypoparathyroidism and what are these clinical signs? |
Albright’s heriditary Osteodystrophy (AHO) Obesity, short stature and shortening of last 3 metacarpal bones when they make a fist. *also you can distinguish from primary hypoparathyroidism because PTH levels will be high, its just the tissue isn't responding* |
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What is the difference between mild hypocalceamia and severe hypocalceamia and what is the treatment for both? |
Mild = low blood Ca levels but no symptoms. Treat with; Calcium tablets, Vit D tablets and magnesium tablets. Sever = low blood Ca levels with symptoms. Treat with; IV Calcium gluconate and eventual VitD therapy. |
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What are the 3 main causes of hypercalceamia? |
Parathyroid mediated = Primary Hyperparathyroidism Non-parathyroid mediated = Malignancy releasing PTHrP (PTH related protein) Medication = Thiazide diuretics and Lithium |
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What is the acronym used to describe the symptoms of hypercalceamia (starts with bones)? |
Bones - Bone pain Stones - Kidney stone formation Groans - abdominal pain Thrones - Polyuria (peeing a lot) Psychiatric overtones - Depression and anxiety in 30% *Plus short QT wave and brady cardia on ECG* |
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Wha investigations to discover the underlying cause for hypercalceamia? |
Examination = Lymph node examination and check other areas of body for malignancy Investigations = PTH levels, Ca/Albumin serum levels, Vit D levels, renal USS for stones, CXR and CT for malignancy *if PTH levels raised then it is a primary hyperthyroidism, if not raised it is malignancy or drug cause* |
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What is the most common cause of a Primary hyperparathyroidism? |
Parathyroid adenoma (benign) |
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What is the management to treat an acute onset of hypercalceamia? |
IV Fluids + Loop Diuretics Bisphosphonates (Try calcitonin if doesn't work) |
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What drug is used in the management of secondary hyperparathyroidism? |
Cinacalcet - mimics calcium to trick PTH levels into falling in response. |
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What type of malignancy commonly induces primary hyperparathyroidism and thus hypercalceamia? |
MEN1 and MEN 2 *typically presents when people are younger, usually multiple glands are involved and there is a high risk of recurrence* |
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What is the most common cause of Secondary Hyperthyroidism? |
Pituitary Adenoma secreting TSH |
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If somebody has Graves disease then what type of antibodies should appear on a blood test? |
TSI Antibodies |
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What is the most common cause of thyrotoxicosis (hyperthyroidism) in the elderly? |
Multi nodular Goiter |
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What are the 4 surgical and medical treatments for Hyperthyroidism? |
ATD’s - Anti Thyroid Drugs RAI - Radioiodine - radiation given off reduces the activity of the thyroid gland Beta blockers - slow down heart rate Surgical excision of thyroid - Thyroidectomy *Usually ATD or RAI never both* |
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What is the main ATD (antithyroid drug) used to treat hyperthyroidism? |
Thionamides - Hormone antagonists acting against thyroid hormones. *Carbimazole and Propylthiouracil* |
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What disease can be caused as a result of the over use of Radiodine treatment in hyperthyroidism? |
70% risk of Hypothyroidism |
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When is Radiodine treatment used to shrink the thyroid gland not advisable? |
Pregnant or breastfeeding Not be suitable if you have eye problems - e.g bulging or double vision |
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What is the most common endocrine disorder after diabetes? |
Hypothyroidism |
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If a patient was diagnosed with primary hyperthyroidism what would be the first medical treatment given to them? |
Carbimazole, then Propylthiouracil |
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What disease is the most common autoimmune cause of hypothyroidism? |
Hashimotos |
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What three things are most important to test in the blood stream when diagnosing hypothyroid disease? |
TSH levels T3/4 levels Autoantibodies: TPO (Thyroid peroxidase antibodies) |
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What is the first line medical treatment for primary hypothyroid disease? |
Replacement thyroxine medication *Levothyroxine (T4) tablets or Liothyronine (T3) tablets, therapy is more aggressive in pregnancy to avoid hypothyroid baby* |
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What are the two autoimmune causes of a goiter? |
Graves’ disease - hyperthyroidism Hashimoto’s disease - hypothyroidism |
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What are the 3 types of Goiter? |
Multinodular Goitre Diffuse goitre - Colloid, Simple CystsTumours - Adenomas, Carcinoma, Lymphoma |
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If a solitary thyroid Goiter/nodule is found then what 4 investigations should be carried out? |
Thyroid function test - to see if the nodule is toxic or not and having an effect on hormone release Isoptope scanning if low TSH: Hot nodule Ultrasound: useful in differentiating benign vs malignant Fine needle aspiration (FNA) Chest and thoracic inlet Xrays if large retrosternal extensions |
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What is the most common type of thyroid cancer? |
Papillary Carcinoma |
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What is the second most common type of thyroid cancer? |
Follicular Carcinoma |
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What is the management for thyroid cancer? |
Near Total Thyroidectomy High dose radioiodine (Ablative) Long term suppressive doses of thyroxine |
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Where does Thyroid Lymphoma and Medullary Thyroid cancer both derive from? (both rarer causes of thyroid cancer) |
Lymphoma of thyroid - May arise from preexisting hashimotos thyroiditis Medullary Thyroid cancer - Tumour arise from parafollicular C cells, Often associated with MEN2 |
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What are the physiological, pharmaceutical and pathological causes of hyperprolactinaemia? |
Physiological - pregnancy, stress Pharmaceutical - Dopamine antagonists Pathological - primary hypothyroidism, pituitary lesions |
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What is the sings/symptoms of hyperprolactinaemia in men and women? |
Women - Galactorrhea (excessive milk production), change in menstrual cycle, infertility Men - in <5% get galactorrhea, impotence, visual field irregularities |
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What is the treatment for hyperprolactinaemia? |
Dopamine antagonists |
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What parts of the adrenal cortex are aldosterone, cortisol and androgens (Testosterone) secreted from? |
G - A F - C R - T Zona glomerulosa = Aldosterone Zona fasciculata = Cortisol Zona reticularis = Testosterone *epinepherine and norepinephrine released from adrenal medulla* |
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What are the two main causes of Addison's disease? *hyposecretion from adrenal gland* |
Autoimmune destruction of adrenal cortex 21- Hydroxylase deficiency - levels of adrenal cortisol decreases but androgen levels increase |
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In addison disease, what will happen to the blood levels of cortisol, ACTH and CRH? |
Levels of cortisol decrease ACTH and CRH levels should rise in response |
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What affects on the body does the reduction in cortisol and aldosterone seen in addison's disease cause? |
Lack of cortisol = Low BG Lack of aldosterone = low BP (due to lack of Na retention), levels of K+ and H+ rise leading to hyperkaleamia and potential acidosis |
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What is the main skin change sign seen in addison's disease? |
Pigmentation of skin (especially in new scars and palmar creases) - caused by in the increased ACTH and CRH production in response to drop in cortisol |
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What are the symptoms of addison's disease? |
Fatigue, weakness, anorexia, depression Impotence Unexplained hypotension and hypoglycaemia leading to collapses Salt craving *think of andy addison and all his symptoms* |
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What is the main investigation for diagnosis addison's disease? |
Synacthen test (aka ACTH stimulation test) ACTH is injected into the blood and then the cortisol levels are measured. In Addison's disease there will be no rise in cortisol levels in response to ACTH. |
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What other blood tests are used in a patient with suspected Addison's disease? |
Random cortisol test (if levels are above 700 you can rule out addisons, if levels are below 700 it could still be addison's) - not such a reliable test due to the circadian nature of cortisol secretion U&Es - decrease in aldosterone causes hyperkaleamia Blood glucose - decrease in cortisol causes drop in blood glucose |
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What is the long term treatment for adrenal insufficiency (Addison's disease)? |
Replacement of glucocorticoid steroids = corticosteroids - e.g Predinsalone Replacement of mineralocorticoids = Fludrocortisone *aka adrenal hormone replacement therapy* |
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What are the 4 rules for when a patient is taking corticosteroids? |
Never miss a dose Dont withdraw treatment too abruptly If they are vomiting/diarrhoea then give IM hydrocortisone If they have infection then double the dosage |
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What is the emergency line of treatment for a patient presenting to A&E with adrenal insufficiency? |
Treat the hyperkaleamia, hypoglycaemia and loss of glucocorticoid. NaCl fluids Glucose Predinsalone/Fludrocortisone |
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What are the ACTH dependent causes of Cushing disease and non-ACTH-dependant causes? *hyper secretion of adrenals* |
ACTH dependent - problem coming from pituitary (e.g pituitary tumour, ectopic ACTH secretion) non-ACTH dependent - problem coming from adrenal cortex (e.g adrenal adenoma) |
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Cushing disease causes a rise in aldosterone and cortisol levels, what affect does this have on the body? |
High aldosterone - increased Na retention = High BP, and it causes increased section of K+ and H+ which can lead to hypokaleamia and alkalosis High cortisol - increased glucose production = diabetes, it is also a catabolic hormone so will increases muscle, bone and skin breakdown |
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What are the main clinical signs of Cushing's disease? |
Moon face Bruising Hump back Oedema/skin ulcers Brittle skin and hair Muscle atrophy/osteoporosis |
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What are the symptoms of Cushing's disease? |
Weight gain Poor labido Face/skin changes Depression Back pain |
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What investigations are carried out on a patient suspected to have Cushing's disease? |
1mg Dexamethasone Supression Test Dexamethasone is synthetic cortisol and in a working body it should reduce ACTH levels when injected in the body and so cortisol levels should reduce too. If levels of ACTH don't reduce you know that there is secondary cause of Cushing's disease (e.g pituitary tumour) *If the levels of ACTH are low and stay low on introduction of dexamethasone you know the problem is coming from the adrenal gland itself* |
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Apart from the Dexamethasone suppression test, what other tests are carried out to determine the source of hyper secretion from the adrenals? |
ACTH blood levels (if pituitary cause = high, if adrenal cause = low) CT/MRI of adrenals and pituitary High dose dexamethasone test - if plasma cortisol levels are not surpassed then suspect ectopic cause or adrenal tumour. |
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What is the treatment for Cushing's disease? |
Metyrapone - blocks cortisol synthesis 11 beta hyroxylase blocker + Treatment of the cause - e.g. tumour resection |
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What is Conn's disease? |
Hyperaldosteronism *common cause of hypertension in under 35s that don't have family history of hypertension* |
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In terms of Na and K levels, what affect does Conn's disease have? |
Increases Na levels = hypertension Decreases K levels = hypokaleamia |
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What investigation determines the difference between primary and secondary hyperaldosteronism? |
Aldosterone:Renin Ratio (ARR) If the ratio of aldosterone to renin is greater than 20 (i.e there is high aldosterone and low renin) = PRIMARY CAUSE If the ratio of aldosterone to renin is less than 20 = SECONDARY CAUSE *if aldosterone is high and renin is low this is because aldosterone is having a negative feedback effect on renin* |
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What is the most common case of primary hyperaldosteronism (conn's disease)? |
Adrenal adenoma |
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Apart from the aldosterone:renin ratio test, what other tests can be carried out to diagnose hyperaldosteronism? |
4hr urine aldosterone levels - confirmatory test Plasma aldosterone levels Suppressed renin activity U&Es - looking for low potassium levels CT scan of adrenal gland |
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What is a Pheochromocytoma a tumour of and how is it detected? |
Tumour of the sympathetic nervous system, 90% are on the adrenal medulla. It is detected by measuring 24hr catecholamine levels, because in Pheochromoctyoma there is a hyper secretion of catecholamines. *very important to test for before medical procedures because it can cause acute cardiovascular compromise - this is why it is always done in the cardio department* |
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Name 4 endocrine causes of hypertension? |
Conn's disease (hyperaldosteronism) Cushing disease Acromegaly Pheochromocytoma |
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A deficiency in that enzyme causes Congenital Adrenal Hyperplasia? |
21-Hydroxylase deficiency - levels of cortisol and aldosterone decrease as a result. *this means cortisol is no longer having a negative feedback effect on ACTH, the continued secretion of ACTH causes adrenals to get bigger and bigger* |
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What is the most common cause of an Addisonian crisis? |
Rapid steroid therapy withdrawal *the adrenal gland is used to getting cortisol supplied for it all the time and so shrinks up, because ACTH secretion has been suppressed, if you suddenly remove the cortisol it can't sustain the demand for producing it by itself* |
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What are the signs that a patient has gone into a Addisonian crisis? |
Sudden penetrating pain in the legs, lower back or abdomen Severe vomiting and diarrhea, resulting in dehydration Low blood pressure - Syncope (loss of consciousness and ability to stand) Hypoglycemia (reduced level of blood glucose)Confusion, slurred speech |
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What are the two most common causes of hypothyroidism? |
Hashimotos Thyroiditis Iodine deficiency |
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What is the most common cause for a goiter? |
Iodine Deficiency - causes thyroid hyperplasia to compensate for lack of iodine intake |
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What are the three most common causes for a multi nodular goiter? |
Cysts Follicular Adenoma - benign Papillary carcinoma - malignant |
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What three investigations would you carry out on a thyroid goiter/nodule? |
TFTs Ultrasound Fine needle aspiration |
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What are the causes of primary hyperparathyroidism and secondary hyperparathyroidism? |
Primary - Adenoma/Hyperplasia Secondary - response to drop in calcium levels due to renal failure |
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What is the most common type of pituitary tumour? |
Pituitary adenoma |
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What are the most common conditions caused by pituitary hyperfunction due to a pituitary tumour? |
Cushings Acromegaly Prolactoneamia |
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What is the effect a growing pituitary tumour can have on the surrounding structures? |
Visual field abnormalities Elevated inter-cranial pressure Compression damage leading to hypopituitarism - 75% of pituitary needs to be lost for hypo function to occur |
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What is the difference between Cushing's syndrome and Cushing's disease? |
Cushing's disease = ACTH dependent, caused by e.g pituitary adenoma Cushing's syndrome = ACTH independent, caused by e.g adrenal adenoma |
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What are the two acute causes of adrenal hypo function (addison's)? |
Steroidal therapy withdrawal Meningococcal Septicaemia |
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What are the causes of primary and secondary chronic adrenal hypo function? |
Primary - Autoimmune, TB, HIV, congenital Secondary - Pituitary failure |
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What is Pheochromocytoma a cancer of? |
Adrenal Medulla *causes increased catecholamine release = increases BP causing hypertension* |
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What type of genetic mutation is a common cause of Pheochromocytoma? |
MEN2 |
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What are the two genetic mutations which are the common cause for tumours of the endocrine glands? |
MEN1 & MEN2 |
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What genetic mutation is the common cause for a pituitary adenoma? |
MEN1 - Wermer syndrome |
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What genetic mutation is the common cause for parathyroid hyperplasia? |
MEN2a *MEN2b is more common in younger patients and more aggressive* |
