AMK

Question 1

Cushing syndrome

Answer 1

Hypercortisolism - High cortisol levels in the body for long period of time

Cortisol - gluccocorticioid , produced by cells in Zona Fasciculata of adrenal cortex

Question 2

Action of Cortisol

Answer 2

Cortisol - Hormone

In Stress - Increase :

• gluconeogenesis
• Proteolysis
• Lipolysis

Increases sensitivity of BV to adrenaline and Noradrenaline (catecholamines) - which cause vasoconstriction to Increase BP

Dampens Immune system

• cause decreased production of prostaglandins + Interleukins
• Inhibits T- Lymphocytes

Effecrs receptors in the Brain - influence mood and memory

Question 3

Effects of Cushings syndrome on body

Answer 3

Bone, Skin, Muscle breakdown
(These contain Big stores of protein. High cortisol levels will break this down )

Hypertension - increased sensitivity of BV to catecholamines increases Vasoconstriction and BP

increase susceptibility to infection

Impaired normal brain fuction

ovarian or testicular function messed up
(inhibts gonadotrpin releasing hormone ) - little or no periods

Elevated Glucose levels - cause high insulin levels - insulin targets adipocytes causing them to accumulate more fat cause central / truckal obesity
(cortisol promotes gluconeogenesis)

Question 4

Symptoms of Cushing’s syndome

Answer 4

Truncal obesity

Muscle wasting , thin extremities

Easy brusing

Abdominal striae

Fractures - Osteoporosis

Diabetes Mellitus

Hypertension

increased susceptibilty to infection

Poor wound healing

Emotional distrubances

amenorrhea - missed menstrual periods (one or more )
oligomenorrhea - infrequent menstral periods (Fewer than 5-8 a year)

TEA MAD PEIH

Truncal obesity , emotional distrubance , amenorrhea , Muscle wasting, abdomial striae, Diabetes, Poor would healing . Easy bruisng , infection . hypertension

Question 5

Causes of Cushings Syndome

Answer 5

excess cortisol from Zona Fasiculata
(adenal carcinoma )
(adrenal adenoma - benign )

excess ATCH from pituary gland
(Pituary adenoma )

Question 6

Treatment of Cushings Syndrome

Answer 6

surgical incision - e.g pituary adenoma

Adrenal steriod inhibitors - Ketoconazole , Metyrapone

Drugs - exogenous steriod
(adrenals may be atrophied so body needs outiside steriod until adrenal gland can recover )

Question 7

HPA axis

Answer 7

hypothamulus (crh)

anterior pituituary gland - ACTH

ADRENAL GLAND -CORTISOL

Question 8

Action of Thryoid Hormone

Answer 8

Heart
promotes normal cardiac output

bone -
promotes normal bone growth
stimulates Bone resorption

Increase Basal metabollic rate
(increases 02 usage, Glycolysis , Gluconeogenesis , lipolysis, LDL uptake )

Stimulates SNS - Fight or Flight

GI tract
(Increases Gut Motility )

Brain
(Increases myelination, dendrites , synaspes )

Promotes normal hydration of the skin

Question 9

Possible Pathologies of Thyroid gland

Answer 9

Hyperthyroidism- overactive thyroid - too much thyroid hormones

Hypothyroidism - underactive thyroid hormone - too little thyroid hormone

Thryoiditis - inflammation

Thyroid adenoma

Question 10

What is Hyperthryoidism , causes ?

Answer 10

Hyperthyroidism - too much thyroid hormone in body

CAUSES

• Autoimmune conditions - Graves disease ,
  (immune system attacks thyroid gland causing it to grow and secrete too much thyroid hormone )
• Thryoid Adenoma
• inflamed/ damaged thyroid gland
• Neonatal hyper T -
  (Maternal Graves disease - Maternal TSH passes across placenta to fetus causing it produce too high level of Thyroid hormone )
• Jod Basedow syndrome - iodine induced thyrotoxicosis
  (iodine deficient person gets a hefty dose of iodine )

Question 11

Symptoms of Hyperthyroidism ?

Answer 11

-Weight loss

• Heat intolerance
  These caused by increased Basal metabolism
• Rapid heart rate (palpitations )
• sweating
• Hyperactivity
• anxiety and insomnia

Thyroid eye disease - signs - bulging eyes ,red, uncomfortable,
(eye muscles, eyelids, tear glands, fatty acids become inflamed cause eyes to be pushed foward. Can acuse double vison - muscle stuffness eye cant move together with each other)

These caused by increased SNS stimulation.

• Osteoporosis
• Congestive heart failure (heart failure ) - red - long term complications

Question 12

Diagnosis of Hyperthryoidism ?

Answer 12

Blood test - test for t3, t4, TSH levels

• Thyroid scan + radioactive iodine uptake test
  (see how much of the tracer ( iodine) the thyroid gland takes up. If it takes up more or less than normal indicates a problem
  more - hyperactive thyroid , less - hypoactive thyroid)

Question 13

Action of Cortisol

Answer 13

Cortisol - Hormone

In Stress - Increase :

• gluconeogenesis
• Proteolysis
• Lipolysis

Increases sensitivity of BV to adrenaline and Noradrenaline (catecholamines) - which cause vasoconstriction to Increase BP

Dampens Immune system

• cause decreased production of prostaglandins + Interleukins
• Inhibits T- Lymphocytes

Effecrs receptors in the Brain - influence mood and memory

Question 14

Types of Thyroiditis

Answer 14

Hashimotos - automimmune - cause underactive thyroid
rarely do surgery - only if goitre is very uncomfortable

• postpartum - immune system attacks after giving birth causes temporary hyperthyroidism , some can then have a spell of hypothyrodism
• silent - similar to postpartum just not related to birth and happens in bith men an women
• drug induced - can cause either hyperthyroidism or hypothyroidism
• Acute / infectious - infection - treat with antibiotics etc, pain relief - ibprofen
• radiation - induced

If hypothyroidism occurs give levothyroxine (t4)

Question 15

What is Hypothyroidism , causes ?

Answer 15

Primary causes

• Hashimoto’s Thyroiditis
  and some other types of thyroidtitis
• Hyperthyroid medications e.g carbimazole, propylthiouracil
• Iodine deficiency
  (iodine needed to make TH)
• Medications
  e. g lithium , Amiodarone

Secondary causes

• Hypopituitarism - causes reduced production of TSH
• tumors
• Infections
• Vascular - Sheerman syndrome - piturary necrosis (due to massive blood loss e.g after child birth )
• Radiation

Question 16

Presentation of Hypothyroidism ?

Answer 16

Constipation

• Amenorrhoea
• Dry skin
• weight gain
• fatigue
• Hair loss/ coarse hair
• Fluid retention - oedema , acites, pleural effusion
  (low temp , lead to fluid accumulation , )

Question 17

What should be seen in investigatioN for Hypothyroidism ?

Answer 17

Blood test results -
Primary hypothyroidism - low t3 + t4
high TSH (no negative feedback from TH)

Secondary Hypothyroidism - low t3 + t4
- low TSH

Question 18

Treatment of Hypothyroidism ?

Answer 18

Levothyroxine - T4 - replace TH

Question 19

What is Hyponaturemia ?

Answer 19

Decrease in serum sodium concentration
- excess of total body water vs total sodium content.

CAUSES

0 renal disease

0 SIADH - syndrome of inappropriate antidiuertic hormone syndrome - most common

0 diuretic use - most common.

0 diarrhea

0 heart failure

0 liver disease.

Question 20

What should be done before confirmation of SIADH ?

Answer 20

Cortisol and thyroid function test , as hyponatremia - is a consequence of :

• adrenal insufficiency
• Hypothyroidism

Question 21

What is the main cation in the intracellular an extracellular space ?

Answer 21

Intracellular - k +

extracellular - na +

Question 22

What are the different types of Hyponatremia ?

Answer 22

0 Hyponatremia - with fluid overload (Hypervalemia )

• peripheral oedema or fluid in lungs

0 with euvulemia (normal volume )

0 With Hyopvolemia

• dehydrated
• fast heart rate.
• low blood pressure.

Question 23

What is Psuedonatremia ?

Answer 23

False reading

1. Hyperglycemia -
   glucose high ——-> draws water in ——-. diluting intravascular space ——-> serum osmolality increased ——-> sodium conc decreased
2. Mannitol - sugar alcohol (treat increased intracranial , intraocular pressure )

cannot move through cells —— > draws fluid into intravascular (extracellular ) compartment from intracellular & intrastitum .

osmolality - high number of dissolved solutes — > in this case mannitol and glucose.

3. Hyperlipidaemia , Hyperproteinaemia

(normal osmolality - proteins and lipids interfere with laboratory analysis when blood sample taken. )

4. TURP = Transurethral resection of the prostate -

large amounts of mannitol or glycine used for bladder irrigation.

• in this case osmolality normal - look for why / .
• in most cases of True Hyponatremia - low osmolality is associated unlike in pseudo where it is either high or normal.

Question 24

Causes of Hypervolemic Hyponatremia which result in relative low sodium in urine?

Answer 24

CAUSES

• Congestive heart failure
  (heart unable to pump blood out effectively —–> lack of arterial blood flow —–> increased thirst ——> secretion of ADH

(so hypervolemia - there is plenty of sodium more water causing dilution. ADH secretion further worsen problem causing water retention in kidney. )

SYMPTOMS

• Raised JVP
• Crackles in lungs
• Dyspnoea
• Wet cough
• peripheral oedema - in legs etc.

LOW SERUM OSMOLALITY- no increase in solutes only water.

0 liver cirrhosis
- reduce albumin synthesis ——> albumin attracts water inside blood vessels (intravascular space ) ——-> less albumin , less water as it moves to interstitual space —–> sodium follows ——> hyponatremia (low blood sodium )

2. Cirrhosis ——- > portal hypertension (hepatic portal system - common complication of cirrhosis) ——> reduced blood flow to heart —–. less blood in arterial circulation —-. increased thirst —–> secretion of ADH.
   - nephrotic syndrome

Damage of glomerulus ——-> protein leaks out —–> hypoalbuminemia —–> low albumin in BV , water not attracted —-> reduced arterial volume —–> trigger thirst —-> secretion of ADH

in all these LOW osmolality

low sodium in urine - as kidney still work so are absorbing NA.

Question 25

Causes of Hypervolemic Hyponatremia which result in relative high sodium in urine?

Answer 25

0 Hyperthyroidism 0 Renal failure