Clinic - Endocrine Flashcards
What are the signs of congenital hypothyroidism
FTT
Macroglossia
jaundice
umbilical hernia
corse facial features
When is the Gurthrie test and what is tested for?
Day 5
Congenital hypothyroidism
SCA
CF
Metabolic diseases eg phenylketonuria
What are the symptons, investigations and treatment of Primary Hyperparathyroidism.
What is the process?
Increased PTH causing increased calicum and calicum blocks transmission
Symptoms - Stones, moans, groans, thrones psychiatric overtones
Investigations. HIGH PTH, HIGH CALCIUM, HIGH URINE CALCIUM LOW PHOSPHATE
Treatment - Surgery, observation
What are the symptoms, investigations and treatment of secondary hyperparathyroidism?
What is the process?
Low calcium causes an increase in PTH
Symptoms - Stones, moans, groans, thrones psychiatric overtones or NONE
Investigations. HIGH PTH, Normal CALCIUM, HIGH PHOSPHATE
Treatment - Surgery, observation
What is the relatioship between calcium and phosphate?
Usually mirror, except in seconday hyperparathyroidism
What are the symptoms, investigations and management of tertiary hyperparathyroidism?
What is the process?
Long term low Calcium leads to hight PTH and high calcium. Different to secondary where calcium levels are normal
Symptoms - Stones, moans, groans, thrones psychiatric overtones
Investigations. HIGH PTH, HIGH CALCIUM, LOW PHOSPHATE
Treatment - Surgery, observation
What are the symptoms and investigations of malignant hypercalcemia?
What is the process?
Malignancy causing high calcium levels. This needs to be addressd by treating the malignancy
Symptoms - Stones, moans, groans, thrones psychiatric overtones and WEIGHT LOSS
Investigations - Low PTH, HIGH Calcium, Low phosphate
What are the symptoms, investiagations, treatment and pathology of hypoparathyroidism?
Symptoms - Diarrhoea, pins and needles, tinnitus, clonus, Increased bone density.
Investigations - LOW PTH, LOW CALCIUM, HIGH PHOSPHATE, HIGH BONE DENSITY
Treatment - with calcium or vitamin D to increase absorption
Pathology - Underactive parathyroid meaning less calcium in the blood but more in the bones
Calcium limits nerve transmission so without it there are postiive nerve signs
This is often associated with surgery
Investigations - LOW PTH, LOW CALCIUM, HIGH PHOSPHATE, HIGH BONE DENSITY
What are the symptoms, investigations, treatment and pathology of pseudohypoparathyroidism?
Symptoms - Should metacarpals and round face - Albrights heriditary dystrophy
Investigations - High PTH, Low Calcium, High phosphate
Pathology - An end organ resistance to PTH so althought it is here there is low calcium, causing symptoms.
Treatment - Vitamin D to try and increase calcium levels
What are the symptoms, investigations, management and pathology of hypomagneasimia?
Symptoms - Tinnitus, diarrhoea, clonus, pins and needles
Investigations - Low calcium, low PTH and low magnesium
Pathology - Magnesium is needed for PTH
Treatment - Magnesium
What are the symptoms, investigations and treatment of hypervitamindosis and what is it associated with?
Symptoms - Stones, moans, groans, bones, psychiatric overtones
Investigations - High Vit D, high Calcium, Low PTH
Treament - Stop diet, steroids for sarcoidosis
Pathology - Associated with diet, or SARCOIDOSIS
Too much VIt D causes increased Calcium and associated symptoms
What are the symptoms, pathology, investigations and treatment of a phaeochromocytoma?
Symptoms - Headache, tachycardia, sweating
Pathology - Tumour of the adrenal medulla
Investigations - Increased 24 hr urine catecholamines Investigate futher via MRI
Treatment - Surgery
Medical Treament - B blockers plus low sodium diet to counteract high BP
What are the symptoms, pathologies and treatments of Cushings disease and cushings Syndrome?
Symptoms - Poor wound healing
Central obesity
Straie/brusing from thin skin and dilated vessels
Buffal hump
Moon face
Depression, fatigue
Hirsutism
Cushings - Increased ACTH and cortisol
Cushings Disease - ACTH producing tumour in pituatry
Cushings Syndrome - Ectopic ACTH production
All of these result in an increased cortisol level and the symptoms mentioned.
Treatment - Surgery or metyrpone. This blocks 11b hydroxylase which makes cortisol
How do you differentiate between Cushings disease and Cushings Syndrome?
Dexamethasone test.
Low dose and low ACTH means its not cushings as levels are falling as normal.
High dose and low ACTH means cushings disease
High dise and no fall in ACTH means ectopic
What are the symtoms, investigations, pathology and treatments of Conns Syndrome?
Pathology - Increased aldosterone causing increased NA and water retention and hypertension
Symptoms - Hypertension, hypernaetremia, hypokaleamia
Investigations - High aldosterone but low renin
high NA, Low K, hypertension
Treatment - Low Na diet/surgery
What is the pathology, symptoms, investigations and treatment of Addisons. What is it associated with?
Pathology - This is adrenal insufficency usually caused by TB or AI.
Symptoms - Hypotension, hypoglycaemia, postural hypotension, hyperpigmentation, N+V, weight loss
Investigations - Hyponaetemia, hyperkalaemia, HIGH ACTH. If you give synctachen (Artificial ACTH) and there is no rise in cortisol, it is Addisons.
Treatment
Hydrocortisone (glucocorticoid)
Fludrocortisone (Minerocorticoid)
What is congenital adrenal hyperplasia and what are the investigations?
A congenital disease with a lack of 21 hydroxylase. This is a key enzyme in the formation or minerocorticoids and glucocorticoids
Investigation - GIve synthetic ACTH and 17hydroxyprogesterone builds up but no 21 hydroxylase
What are the two types of CAH?
Salt Wasting - N+V, FTT, hyponaetremia. This is due to a decrease in corticoids.
Treat with hydrocortisone, fludrocortisone
Virilising - Clitoromegaly, hirsuitism, ambiguous genitalia. This comes about due to an increase in androgens as a result of a decrease in corticoids
Treat with oestragen, dexamethasone to suppress ACTH
What are the symptoms, investigations, pathology and treatment of male primary hypogonadism?
Symptoms - baldness, loss of libido, small or absent testicles, gynacoemastia, infertility
Investigations - High GNRH, HIGH LH/FSH, Low Testosterone
Treatment - Testosterone
Examples - Chemo, undescended testicles, Klinefelter 47XXY
What are the symptoms, investigations and pathology of male secondary hypogonadism?
Pathology - This is a problem with the stimulation of the gonads. Eg a pituatry tumour, diabetes
Symptoms - baldness, loss of libido, small or absent testicles, gynacoemastia, infertility
Investigations - Low GNRH, LOW LH/FSH, Low testosterone
What are the symptoms, pathology, investigations and treatment of foetal androgen insufficiency?
Symptoms - A women with infertility, amenorrhea
Investigations - High testosterone, XY karyotype
Pathology - This is a resistance to androgens in the womb making a man have female characteristics
Treatment - Surgery, testosterone
What are the symptoms, pathology, investigations and treatment of PCOS
Symptoms - Amenorrhea, acne, virulence, infertility
Investigations - HIGH androgen, High FSH:LH ratio
Pathology - This is confirmed via US and is linked to diabetes
Treatment - Oestrogen and infertility treatment
What are the symptoms, pathology, investigations and treatment of ovarian tumour?
Symptoms - Weight Loss, amenorrhea, hirsutism
Investigations - High testosterone, CA125
Confirmed via US/CT
Treatment - Treat the cancer
What are the symptoms, pathology, investigations and treatment of Turners
Symptoms - Webbing, short, lymphodeama of hands and feet
Investigations - High FH/LSH, Low oestrogen, Low GH
Pathology - 46 XOnly one female chromosome
Treatment - Oestrogen or GH if young
What are the symptoms, pathology, investigations and treatment of precocious puberty
Symptoms - Early menarche
Investigations - High GNRH, LH/FSH, oestrogen for her age
Treatment - LNRH/GNRH analogues for negative feedback
What are the symptoms, pathology, investigations and treatment of premature ovarian failure
Symptoms - amennorhea before 40 for 6 months, hot flushes, low libido
Investigations - HIGH FSH x2
Treatment - Ovum replacement, Oestrogen
- When can an addisonian crisis occur?
- what are the symptoms?
- Management
1) Undiagnosed Addisons or Infection
1) Vomiting and dehydration
- Hypotension
- Lethargy
- convulstions
- Pain
- Confusion
- Fever
3)Iv saline/glucose/hydrocortisone
Treat long term with hydrocortisone and fludrocortisone
What are the key symptoms in T1DM?
- Polyuria
- Polydypsia
- Weight loss
also
- Candida
- Enuresis
- tiredness
What are the symptoms of DKA?
- Acetone breathe
- Vomiting/dehydration
- Abdo pain
- Hyperventilation
- Hypovolaemic shock
- Coma and death
What are the diagnostic levels for DM?
1) Symptoms
PLUS
Random glucose >11.1 (or equal)
Fasting glucose > 7 (or equal)
OGTT >11.1 (or equal)
2) No symptoms plus the above values on two occasions
What are the two complications of T1DM?
- Hypoglycaemia
- DKA
What is the treament of DKA?
- Fluids
- Insulin infusion - 0.05 - 0.1 U/kg/hour
- Potassium as insulin and rehydration reduces it
- Bicarb if shocked or not responding
- Reestablish fluids and subcut insulin
