Year 3 core conditions > endocrine > Flashcards

endocrine Flashcards

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1
Q

who gets type 1 diabetes

A

10%
presents in children and young adults and persists into adult life

associated with HLA genes

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2
Q

cause of type 1 diabvetes

A

autoimmune destruction of beta cells in the islets of langerhans
initiated by poorly understood environmental factors acting on a genetically susceptible group of ppl

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3
Q

risk factors for type 1 diabetes

A

genetics - 15% have first degree realtive with it

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4
Q

presentation of type 1 diabetes

A

hyperglycaemia ( random >11)
polyuria, polydipsia, wieght loss, excessive tiredness, dehydration/thirst, starvation symptoms

ketoacidosis
atherosclerotic complications due to hyperlipidaemia
peripheral neuropathy

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5
Q

normal blood glucose

A

3.5-5.5mmol/L

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6
Q

diagnostic criteria for diabetes

  • fasting
  • 2hr plasma glucose
A

fasting >7

2hr >11.1

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7
Q

investigations for type 1 diabetes

A

HbA1c - average Hb over 3 months
blood glucose - fasting, 2hr plasma
urine dipstick

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8
Q

treatment of type 1 diabetes

A

insulin therapy
blood glucose monitoring
diet, physical activity etc management

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9
Q

cause of type 2 diabetes

A

combinationof inuslin resistance/insensitivity and insulin deficiency

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10
Q

risk factors for type 2 diabetes

A 
obesity and inactivity
family history
ethnicity
history of gestational diabtes
poor dietary habits
drug treatments - statins, corticosteroids, thizide+betablocker
metabolic syndrome
low birthweight for gestational age
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11
Q

presentation of type 2 diabetes

A

persistnet hyperglycaemia
thirsty, polyuria, blurred bision, wieght loss, recurrent infections, tiredness
insulin resistance - acanthosis nigricans

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12
Q

signs of type 2 diabetes on examination

A

diabetic neuropathy

diabetic retinopathy

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13
Q

investigations for type 2 diabetes

A

HbA1c

plasma glucose levels

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14
Q

treatment of type 2 diabtes

A

lifestyle advice and drugs
metformin - gradual increase of dose to minimise GI upset
monitor renal fucntion

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15
Q

second line to metformin

A

metformin + gliptin

pioglitaxone or sulfonylurea

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16
Q

who gets hypothyroidism

A

3% of pop

10x more in women

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17
Q

causes of hypothyroidism

A 
iodine deficiency
autoimmune thyroiditis (hashimotos or atrophic)
post ablative therapy or surgery
drugs
transient thyroiditis
thyroid infiltrative disorders
congenital
seocndfarycauses - pituitary or hypothalamic
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18
Q

thyroid infiltrative disorders

A 
amyloidosis
sarcoidosis
haemochromatosis
tuberculosis
sclerodermas
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19
Q

presentation of hypothyroidism

A

slow metabolism:
tiredness, weight gain, anorexia, cold intolerance, poor memoey, change in appearance, depression, low libido, goitre, puffy eyes, brittle hair, coarse skin, arthalgia, myalgia, muscle weakness/stiffness, constipation, menorrhagia, oligomenorrhagia, psychosis, coma, deafness

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20
Q

signs of hypothyroidism on examination

A 
poverty of movement
peaches and cream complexion
loss of eyebrows
hypertension
eart fialure
bradycardia
pericardial effusion
carpal tunnel 
oedema
periorbital oedema
deep voice
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21
Q

investigations for hypothyroidism

A

blood tests for TSH, serum T4 and thyrpid antibodies

T3/T4 low
TSH raised (if low, lesion of hypothalamus or pituitary is likely)
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22
Q

treatment of hypothyroidism

A

lifelong tlevothyroxine

further assessment of thyroid function

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23
Q

who gets hyperthyroidism

A

10x more in women
increases w age
higher in areas of iodine deficiency
0.75%

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24
Q

causes of hyperthyroidism

A

autoimmune - graves disease
TSH secreting pituitary adenoma
thyroiditis
exogenous intake of thyroid hormones - factitious thyrotoxicosis

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25
risk factors for hyperthyroidism
female FHx smoking low iodine intake and autoimmune diseases (type 1 diabetes)
26
presentation of hyperthyroidism
weight loss, heat intolerance, sweating (stimualted metabolism) tremor, nervousness, irritability, emotional disturbacne, tiredness, lethargy cardiac features caused by beta adrenergic sympathetic activity, palpitations, tachycardia and arrhythmias eye signs range in severity
27
thyroid storm
thyrotoxic crisis - precipitated by non-thyroid surgeyr, major trauma, infection, imaging studies withiodinated contrast medium in patients with unrecognised thyrotoxvicosis = insomnia, anorexia, vomiting, diarrhoea, marked sweating, fever, tachycardia, immediate management is required
28
investigations of hyperthyroidism
TFTs decreased FSH increased Y4 and T3 (except pituitary) +ve serology for autoantibodies radioactive iodine scan
29
treatment of hyperthyroidism
medical - anithyroid drugs block hormone synthesis = carbimazole, beta blockers (tahcy and tremor), radioactive iodine, surgical - total thyroidectomy (graves) or lobectomy (nodules or adenomas) chpice for those not indcate d for I131 therapy and those with eye conditions
30
differentials of hyperthyroidism
AF panic attakcs parkinsons
31
who gets goitres/thyroid nodules
women >men
32
causes of diffuse goitre
``` physiological - puberty or pregnancy autoimmune (graves or hashimotos) acute viral thyroditis iodine deficiency dyshormonogenesis goitrogens ```
33
causes of nodular goitre
multinodular goitre solitary nodule fibrotic (reidells thyroiditis) cysts
34
types of tumour - goitre
adenoma carcinoma lymphoma
35
causes of miscellaneous goitres
sarcoidosis | TB
36
risk factors of goitr
family history age - younger than 20 and older than 70 gender - male for cancer radiation exposure
37
presentation of goitre/nodules
``` goite noticed discomfort and pain in neck occasional tracheal or oeseophageal compression - difficulty breathing and swallowing bruit present and associated lymphadenopathy (malignant) ``` hoarseness of voice (hyperthyroidism)
38
investigations of goitre
blood tests - thyroid function tests imaging - thyroid USS, FNA under US, ches tand thoracic inlet xray - detect tahceal compression and large retrosternal extensions thyroid scan using radioactive iodine
39
treatment of goitre
usually not required apart from introducing euthyroidism surgical intervention required for cosmetic effects of large goitre pressure effects on trahcea or oesoep`hagus or confirmed/possible malignancy
40
cushings disease
excess glucocorticoids reuslting from innapropriate ACTH secretion from the pituitary (usually microadenoma, less often cortophin hyperplasia)
41
cushings syndrome
abnormalities reuslting from a chronic exces sof glucocorticoids whatever the cause
42
cushings mortality if untreatewd
5 year mortality of 50% if untreated
43
causes of cushings syndroem
exogenous = administration of synthetic steroids or ACTH for treatment of medical conditions endogensou - adrenal tumour or excess ACTH - pituitary tumour = cushings disease or from ectopic site spontaneous = rare- 2/3 from excess ACTH secretion from pituitary gland pseudoushings - alcohol excess mimics cushings
44
presetnation of cushings
obese - central, truncal obesity plethoric complexion moon face easy brusing, purple striae on abdo, breast and thighs
45
signs on examination of cushings
``` mon face plethora depression/spychosis ACNE hirsutism frontal balding thin skin bruising poor wound healing pigmentation skin infection hypertension pathological fractures osteoporosis kyphosis buffalo hump central obesity striae oedema proximal myopathy proximal muscle wasting glycosuria ```
46
investigations of cushings
first confirm presenc eof cortisol excess then determine cause: measure free cortisol - blood or saliva late at night dexamethasone su[pression test (should suppress ACTH production and decrease cortisol, will not in cushings due to endogenous source of cortisol) ACTH plasma levels - low = adrenal adenomas and carcinomas, high = cushings, ectopic ACTH production imaging - MRI of pituitary (cushings), CT of adrenals, CT chest, abdo or pelvis (ectopic site suggesyed) corticotrophin releasing hormone test
47
treatment of cushings
exogenous medications gradually decreased (avoid sudden withdrawal) pituitary adenoma - surgical excision adrenal steroid inhibitors - ketoconazole +metyrapone +ectopic ACTH production
48
who gets parathyroid adenomas?
post menopausal women mostly
49
what gene is parathyroid adenoma associated with?
MEN1
50
how does parathyroid adenoma present?
bones - aches/pains localised in larger joints stones - calcium based renal stones Moans - psychological/psychiatric symptoms (lethargy, depressed mood) Groans - non specific GI symptoms (abdo pain, constipation)
51
signs on examination of parathyroid adenoma
polyuria, polydipsia and nocturia | hypercalcaemic crisis in those exposed to severe dehydration (diarrhoea, vomiting)
52
investigations for parathyroid adenoma
raised corrected serum calcium if unexplained = very suggestive increased serum parathyroid hormone concentration in presence of hypercalcaemia is diagnostic high resolution US may identify tumours
53
treatment of parathyroid adenoma
without localisation scans, bilateral neck expolration and removal of large tumours is standard if location is known, minimally invasive parathyroidectomy
54
who gets primary hyperparathyroidism
mostly post menopausal women
55
causes of primary hyperparathyroidism
most have single parathyroid adenoma some have multiglandular hyperplasia - sporadic disease or in association with familial disease parathyroid cancer is rare
56
risk factor for parathyroid adenoma
MEN syndromes
57
presentation of primary hyperparathyroidism
BONES, STONES, MOANS and GROANs * Bones: Aches/pains localised in larger joints * Stones: Calcium based renal stones * Moans: Psychological/psychiatric symptoms (lethargy, depressed mood) * Groans: Non-specific GI symptoms (abdominal pain, constipation)
58
signs on examination of primary hyperparathyroidism
polyuria, polydipsia, nocturia common symptoms many non specific symptosm put down to getting older hypercalcaemic crisis if exposed to severe dehydration
59
investigations of primary hyperparathyroidism
increased PTH in presence of hypercalcaemia is diagnostic high res US to identify tumours sestamibi scanning used to localised adenomas
60
treatment of primary hyperparathyroidism
minimally invasive parathyroidectomy
61
causes of addisons disease
Autoimmune response that attacks the cortex of the adrenal gland where cortisol and aldosterone is made most of the time by organ specific autoantibodies. assoicated with autoimmune conditions such as thyroid disease, ovarian fialure, pernicious anaemia, DM T1 Rarer causes - adrenal gland tuberculosis, surgical removal, haemorrhage, malignant infiltration
62
secondary hypoadrenalism
pituitary disease
63
tertiary hypoadrenalism
hypothalamic disease
64
signs on exmaination of Addison's disease
lethargy, depression, anorexia, weight loss postural hypotension - salt and water loss is an early sign hyperpigmentation vitiligo and loss of body hair in women crisis presentation: vomiting, abod pain, profound weakness, hypoglycaemia and hypovolaemic shock
65
investigations of Addison's disease
3 fold to demonstrate low cortisol secretion and determine if independent or dependent on ACTH secretion - single cortisol measurement - short ACTH stimulation test (diagnostic but does not diff between secondary and primary) - plasma ACTH level (high ACTH + low cortisol = primary, both low = secondary or tertiary) - adrenal antibodies are detected in most cases
66
treatment of addisons disease
lifelong steroid replacement - hydrocortisone 20mg waking and 10mg in eve to mimic diurnal rhythm - fludrocortisone - 50-300mg daily
Year 3 core conditions
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