Karteikarten
2 - Endocrinology
Karten in diesem Stapel (161)
- 1what are 4 common problems with the thyroid?hyperthyroidism
hypothyroidism
goitre
carcinoma - 2what are 4 common problems with the adrenals?addisons
cushings
conns
phaeochromocytoma - 3what are 2 common problems with the pancreasT1DM
T2DM - 4what are 2 common problems with the parathyroid glands?hyperparathyroidism
hypoparathyroidism - 5what are 3 common problems with the pituitary and hypothalamus?hyperprolactinaemia
phyopituitarism
tumours - 6what are clinical signs of hypothyroid?facial swelling, hair loss, decreased HR, husky voice, hypothermia, goitre
- 7what are clinical signs of hyperthyroid?tremor, warm skin, agitation, goitre, exophthalmous, AF
- 8what thyroid markers are present in hypothyroidlow t4 and t3
high TSH
(but in secondary hypothyroidism, TSH will be low too as the problem is higher up e.g. the pituitary) - 9what thyroid markers are present in hyperthyroidhigh t3 and t4
low TSH - 10what causes primary hypothyroid?autoimmune
anti-thyroid meds
thyroidectomy
amiodarone - 11what causes secondary hypothyroid?pituitary tumour
- 12what is another word for hyperthyroid?thyrotoxicosis
- 13what is the most common cause for hyperthyroid?graves disease (autoimmune)
- 14what drug is well known for inducing thyroid disease?amiodarone
- 15what is exophthalamous?bulging eyes in hyperthyroid - caused by graves disease - immune system attacks the muscles and fatty tissues behind the eyes = inflamed and swollen
- 16what are symptoms of hypothyroid?fatigue, constipation, weight gain, depression, menorrhagia, psychosis, hearing loss
- 17what are symptoms of hyperthyroid?palpitations, diarrhoea, weight loss, sweating, heat intolerance, hunger and thirst, anorexia
- 18what is the aim in thyroid disease management?restore wellbeing and return TSH to normal levels
relieve symptoms
manage any underlying condition - 19what 2 things are monitored in thyroid disease?TFTs - t3, t4, TSH
patient symptoms - 20why does amiodarone cause problems with the thyroid?it contains 40% iodine = causes hypo and hyper thyroid
HYPO - directly inhibits thyroid gland function
HYPER - inflammatory response that increases release of thyroid hormones - 21what other drugs can induce thyroid disease? (4 things)-lithium (unknown mechanism)
- iodine
- cholestyramine and ferrous sulphate (decrease absorption of thyroxine)
- glucocorticoids (decrease TSH secretion) - 22which patients need thyroid screening?pts taking amiodarone and lithium
pts with diabetes, AF or hyperlipidaemia
pts with downs syndrome, turners syndrome or addisons disease - 23what link do thyroid hormones have to the heart?thyroid hormones have a direct effect on BP, pulmonary hypertension and HF = changes in cardiac output, contractility, bp and rhythm disturbances
- 24what is turners syndrome?absence of one of the two X chromosomes
- 25what is downs syndromechromosome 21
- 26what is addisons disease?adrenal glands leading to decreased cortisol and aldosterone
- 27what CV symptoms does hypothyroid cause?decreased contractility, increased vascular resistance, increased cholesterol, increased CRP
- 28what CV symptoms does hyperthyroid cause?palpitations/angina/chest pain/AF, exertional dyspnoea, cardiac hypertrophy and hypertension, peripheral oedema and congestive HF
- 29does altered CV function reverse?yes when thyroid function is restored
- 30what is adrenal insufficiency?deficient production of glucocorticoids (with or without deficiency also in mineralocorticoids and adrenal androgens)
- 31what do the adrenal glands normally release?aldosterone
cortisol
androgens
steroids e.g. mineralocorticoids, glucocorticoids and gonadocorticoids - 32what 4 diseases occur in adrenal dysfunctioncushings syndrome - excess cortisol
addisons disease - lack of cortico and mineralo-corticoids
conn's syndrome - excess aldosterone
phaeocromocytoma - tumour causing excess release of adrenaline and noradrenaline - 33what causes cushings?normally rug induced e.g. steroids
- 34what causes addisonsnormally autoimmune
- 35what are symptoms of addisonsanorexia and weight loss, weakness, dizzy, low BP, low Na and high K
- 36how do you treat addisons- mineralocorticoid replacement = fludrocortisone
- glucocorticoid replacement = hydrocortisone - 37what is increased in cushing's disease?high levels of cortisol in the blood
- 38what causes cushing's disease?taking glucocorticoids
pituitary tumours - 39what is cushing's syndrome? what is cushing's disease?syndrome is high cortisol
disease is when a pituitary tumour cause high ACTH = high cortisol - 40what is the test for cushing's disease?do dexamethasone suppression test --> if cortisol level is suppressed then probably not cushings
- 41what do the adrenal glands make?cortisol
aldosterone
androgens - 42what does cortisol do naturally?regulates bp and immune system
helps body respond to stress
helps balance insulin in regulating BG - 43what happens when the hypothalamus senses low levels of cortisol?hypothalamus releases CRH = acts on pituitary = releases ACTH = makes adrenal make cortisol
- 44what is looking 'tanned' a symptom of?addisons - due to increase in ACTH
- 45what happens to your BP in addisons?often get postural hypotension
- 46what symptoms do you get from adrenal insufficiency?weakness, fatigue, anorexia, abdo pain, weight loss, orthostatic hypotension and salt craving
- 47what biomarkers are common in addisons?low Na and blood glucose
high K, urea, Ca and serum TSH - 48what mental changes happen in addisonsdepression
- 49what tests can you do for addisons diseaseshort syacthen test = give tetracosactide which is a chemical copy of ACTH and measure serum cortisol (addisons = low cortisol)
increased levels of plasma adrenocorticotropic hormone - 50what is the pneumonic for addisonsa - always tired
d - dizzy when standing
d - drop in bp when standing
i - inexplainable weight loss
s - skin colour changes
o - only eating sparingly
n - no strength in handgrip or limbs
s - sick/nausea - 51what should you do in an acute adrenal crisis?call 999, and give iV hydrocortisone and iv fluids
- 52what are the risks of adrenal crisis?coma, death, cardiac arrest, stroke, hypovolemic shock, hypoxia, hypoglycaemia
- 53whats the problem with taking corticosteroids for adrenal insufficiency (SE)reduced bone mineral density - HC doses over 25mg is a risk for fractures
- 54what should we encourage when taking corticosteroidsvitamin d and calcium intake optimised
encourage weight bearing exercise
well balanced diet
stop smoking and limit alcohol - 55what should we monitor in addisonsBP
adrenal function
U+E
BG
TFTs
signs and symptoms - 56what should you do if you have a fever of 37.5 degrees or more?double normal dose
- 57what should you do if you have a fever of 39 degrees or more?triple normal dose
- 58xwhat should you do if you have a fever of 40 degrees or more?call a doctor
- 59what should you do if you have a serious injury?take 20mg HC immediately (in addition to normal dose)
- 60what should you do if you vomit?take 20mg HC immediately after, and make sure you drink fluids to avoid dehydration
- 61what should you do if you vomit twice or more?emergency injection of HC and call doctor for advice
- 62what should you do if youre due to have a medical procedure?make sure they know you have addisons as you will need extra HC
- 63when do you need extra hydrocortisone?infection
accident
operation
ill
strenuous exercise - 64what are adrenal crisis symptoms?vomiting, abdo pain, myalgia, joint pains, severe hypotension, hypovolemic shock
- 65when should steroids be taken?morning and lunchtime
- 66what drugs interact with addisons meds?- oestrogen decreases metabolism of HC
- pifampicin and phenytoin increase metabolism of HC
- liquorice interferes with fludrocortisone (in cough syrups) - 67what vaccine are addisons pts advised to have?flu vaccine every year
- 68what is the renin angiotensin system?angiotensinogen --> angiotensin 1 --> angiotensin 2
- 69what does angiotensin 2 do?causes water and salt retention = increases volume = increases BP
- 70what do ADH/ vasopressin do?control water content in the body
- 71what 2 diseases can hypo-pitutarism cause?dwarfism - deficient in growth hormone
diabetes insipidus - ADH deficiency - 72what causes hypo-pitutarism?tumours/radiotherapy/surgery/infection/ head injury
- 73how do you treat dwarfismgive somatropin (growth hormone) or IGF-1
- 74how do you treat diabetes insipidusvasopressin/desmopressin/terlipressin
- 75what 3 diseases can hyper-pituitarism cause?gigantism/acromegaly - excess growth hormone
hyper prolactinaemia - excess prolactin
SIADH - excess vasopressin - 76how do you treat gigantism / acromegaly?bromocriptine or cabergoline and octreotide (dopamine agonists)
- 77how do you treat hyperprolactinaemia?bromocriptine or cabergoline
- 78how do you treat SIADH?demeclocycline
- 79what changes in electrolytes does SIADH cause?low Na - esp in elderly
- 80what causes SIADHcps disorders, head injury, meningitis, enceph, brain tumour, haemorrhage, leukaemia, lymphoma, pneumonia, TB, emphysema, asthma, lithium, tetracylines, carbamazapine, thiazides, MAOIs, SSRIs, cytotoxics and hypotonic fluids post-op
- 81where are pituitary tumours normally from?breast metastases
- 82what 3 things do pituitary hormones cause?1 - pressure effects from tumour
2 - pituitary failure
3 - hypersecretion of hormones - 83what is pituitary macro adenoma?tumour causing visual disturbances due to compression of the optic nerves
- 84how do you treat non functioning tumours?surgery
- 85whats the goal of non functioning tumour treatment?protect eyesight
restore pituitary function - 86what do functioning tumours releaseprolactin mostly
(maybe GH /ACTH /TSH /FSH) - 87what does excess prolactin cause?women - no periods, infertility and galactorrhoea
men - erectile dysfunction - 88how do we decrease prolactin?dopamine receptor agonists - prolactin is inhibited by release of DA
e.g. cabergoline and bromocriptine - 89what causes acromegalytoo much growth hormone
- 90how is acromegaly treated?first line is often surgery
or somatostatin analogues e.g. octreotide or lanreotide - 91what are important SE of somatostatin analoguesgall stones and glucose intolerance
- 92how do you treat cushings?surgery
metyrapone in preparation for surgery to block HC synthesis - 93what drugs are used as hormone replacement - 5growth hormone
oestrogen/testosterone (LH and FSH)
thyroxine (TSH)
cortisol (ACTH)
desmopressin (vasopressin) - 94who qualifies for growth hormone treatmentstimulation test must prove GH deficiency
have a low QoL
3-9 month trial with improvements - 95what testosterone replacements are available?IM injections e.g. nebido
gels - 96what are 2 important side effect of testosterone?increases RBC production in bone marrow = increase haematocrit and Hb = strokes
prostate cancer - 97how is hydrocortisone dosed?normally 10mg OM, 5mg lunch, 5mg early evening
- 98what should you do to the HC dose if theres sever shock or long haul flight?double dose
- 99what does desmopressin do?acts on kidney collecting ducts to allow water reabsorption
- 100when should desmopressin be takenat night, then according to symptoms during the day
- 101what is desmopressins aim?control polyuria
- 102when should steroids be taken?in the morning as natural hormone release is highest at 6am
- 103name 1 mineralocorticoidaldosterone
- 104name 3 glucocorticoidscortisol
corticosterone
cortisone - 105what do the thyroid gland use iodine for?to make t3 and t4
- 106what protein makes thyroid hormonesTSH
- 107is there ore t3 or t490% is t4
- 108what do thyroid hormones dostimulate fat, protein and carb metabolism
- 109whats the most common cause of addisons in undeveloped countries?TB
- 110what is graves disease?autoimmune - TSH rec stimulating antibodies = TSH rec always active - hyperthyroid
- 111how do you treat hyperthyroid?carbimazole or propylthiouracil
thyroidectomy
radio iodine - 112why do you give beta blockers in hyperthyroid?help with adrenergic symptoms
- 113what causes hypothyroidautoimmune
thyroid damage after surgery or radio iodine - 114what non specific symptoms can indicate hypothyroid?constipation
hoarse voice
feeling cold
puffy eyes
weak muscles
bradycardia
hair loss and dry skin
macrocytic anaemia - 115how do you treat hypothyroidismlevothyroxine
- 116which group of patients is cautioned with levothryoxine?elderly - esp those with cardiac disease
- 117can levothyroxine be given weekly?yes in pts who forget to cant self medicate
- 118whats the major SE of carbimazole and propylthiouracil?agranulocytosis - caution in symptoms of infection
- 119what is myxoedema coma?untreated hypothyroid
- 120what do you need to make sure before starting thyroxine therapy?they don't have glucocorticoid deficiency - prevent a hypo adrenal crisis
- 121when is levothyroxine best taken?morning - has a long t1/2
- 122how long does TSH take to stabilise after a change of dose?6 weeks
- 123what is thyroiditis?viral or autoimmune attack - release of preformed thyroid hormones = painful and enlarged thyroid gland
- 124if you think someone has hyperthyroid but not sure - should you treat?NO wait until you have results and know for use - can safely watch
- 125what should thyroid hormone levels be like before surgery or radio iodine?need to be euthyroid
- 126should you monitor WCC on carbimazole and PTU?no as agranulocytosis is rare - just cation for infective symptoms
- 127what should be given for myxedema in hyperthyroid?steroid creams in joints e.g. betamethasone
- 128what are symptoms of thyroid crisisuntreated hyperthyroid
tachycardia, muscle weakness, sweating, vomiting, anxious and psychotic - 129how do you treat thyroid crisis?high dose PTU, legions iodine, IV glucocorticoids and B blocker
- 130if amiodarone is causing hypothyroid - what do you do?just take levothyroxine along side it
- 131why are pts given lithium as an adjunct in hyperthyroid?inhibits t3 and t4 release from thyroid
- 132why are hypothyroid pts given IV calcium gluconate and long term vit DHYPOTHYROID - less PTH due to failure of the gland - hypocalcaemia
use alfacalcidol - 133why are hyperthyroid given bisphosphonates?hyperthyroid - high levels of PTH - high levels of calcium - given bisphosphonates
- 134what increases the risk of graves disease?history of autoimmune diseases
family history of thyroid problems
smokers
stress
immunosuppressants
giving birth - 135when do pregnant women get thyroid problems?hyperemesis gravidarum = gestational hyperthyroid
- 136which patients should receive anticoagulation?hyperthyroid and AF
- 137what are the 2 possible regimes after euthyroid?block and replace = thionamide drug kept constant = block thyroid hormone production, levothyroxine added to maintain euthyroidism
titrated = thionamide dose is progressively lowered at regular intervals to allow endogenous synthesis of thyroid hormone to continue in a regulated fashion - 138how does radio iodine work?accumulates in thyroid after oral ingestion - then releases radiation to kill thyroid
- 139why do you want pts euthyroid before giving radio iodine?to avoid thyroid storm
- 140when is radio iodine contraindicated?pregnancy and lactation
- 141why shouldn't antithyroid drugs be used to treat thyroiditis?inflective - give beta blocker for symptoms
- 142what can cushings cause if left untreated?increased BP = MI and stroke
- 143what 3 hormones are excreted by the thyroid and what are their functionst3 and t4 - regulate metabolism, protein synthesis and bone/cell growth
calcitonin = regulates levels of calcium in blood - 144where does iodine come from?diet as not made in the body
- 145why do you get a goitre?when there not enough iodine to make thyroid hormones - feedback systems cause thyroid to work harder = enlarged gland
- 146what are the 2 main physiological actions of thyroid hormones- development and growth
-metabolism - 147what 2 drugs can cause drug induce thyroid diseaseamiodarone
lithium - 148how do you treat iatrogenic cushings?remove steroid
- 149how do you treat endogenous cushings?surgery to remove tumour
- 150what does a high TSH level imply?that its primary hypothyroid, as secondary is from pituitary and TSH isn't involved there
- 151angina and levothryoxine - whats the risk?too high dose can make angina worse - give 25mcg levo
- 152what are treatment goals of levothyroxine?pt feel better
reduce TSH levels by titrating thyroxine up - 153what beta blocker should be used in hyperthyroid?propranolol
- 154give an example of block-replacement therapycarbimazole for 6-8 weeks to get hypothryoid, then add levothyroxine for 18 months
then withdrawal drugs and check pt for recurrence of thyrotoxicosis - 155what are advantages of block-replace?less monitoring
less hospital admissions
avoid over/under treatment - 156what should you do if someone is in AF when hyperthyroid?don't treat - see if theyre still in AF when euthyroid
- 157which people pay for meds - hypo or hyper thyroid?hyper pay
hypo don't! - 158why do addisons pts take levothyroxine?most are hypothyroid
- 159when addisons pts ae in hospital - is it better to give more or less hydrocortisone?give more if not sure - better to have more than to go into adrenal crisis
- 160when do you get adrenal suppression with steroids?longer than 3months treatment
- 161if a pt more than 3 months of 3 excerbations of asthma treated with steroids - what are they at risk of?osteoporosis
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- Masters Clinical Karteikarten am 2 - Endocrinology, erstellt von lw409 am 24/04/2015.
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