Endo Flashcards
4 causes of hypovolaemic hyponatraemia with low urine sodium (<20)
- normal kidney function
a) vomiting
b) diarrhoea
c) trauma
d) burns
3 causes of hypovolaemic hyponatraemia with high urine sodium (>20)
- renal loss
a) Addison’s
b) diuretics
d) renal failure (CKD)
3 causes of hypervolaemic hyponatraemia
a) heart failure
b) nephrotic syndrome
c) liver failure
causes of euvolaemic hyponatraemia with high urine sodium (>20)
SIADH
causes of euvolaemic hyponatraemia with normal urine sodium
- hypothyroidism
what is pseudohyponatraemia
low sodium with high/normal serum osmolarity
causes of pseudohyponatraemia
normal serum osmo:
- hyperlipidaemia, hyperproteinaemia
high serum osmo:
- hyperglycaemia, mannitol
causes of SIADH
a) drugs: SSRIs, sulphonylurea, PPI
b) chest: small cell cancer, TB
c) neuro: infection, SAH
management of SIADH
fluid restriction + vaptans
effect of pituitary tumour on visual field
bitemporal hemianopia
management of hypervolaemic hyponatraemia
fluid restriction + furosemide
management of hypovolaemic hyponatraemia
slow infusion of saline
complication of untreated hyponatraemia
cerebral oedema
complications of rapid correction of hyponatraemia
osmotic demyelination syndrome (locked in syndrome)
3 causes of hypernatraemia
- dehydration
- diabetes insipidus
- Conn’s, Cushing’s
complications of rapid correction of hypernatraemia
cerebral oedema
HPG axis in prolactinoma
i) too much prolactin stops kisspeptin in
hypothalamus
ii) less GnRH
iii) less LH & FSH
-> dopamine stops prolactin
what are other causes of raised prolactin
- pregnancy
- PCOS
- metoclopramide
prolactinoma presentation in men
low libido
erectile dysfunction
infertility
gynaecomastia
headache
bitemporal hemianopia
prolactinoma presentation in women
low libido
amenorrhoea
infertility
galactorrhoea
headache
bitemporal hemianopia
prolactinoma investigations
i) urine beta HCG
ii) high prolactin > 6000
iii) low LH & FSh
iv) pituitary MRI
prolactinoma treatment
i) cabergoline (dopamine agonist)
ii) surgery only if cabergoline fails
acromegaly presentation
coarse facial features
big hands
prognathism
headaches
bitemporal hemianopia
sweating
acromegaly investigations
i) plasma IGF-1
ii) oral glucose tolerance test (diagnostic)
- GH rises instead of falling
iii) pituitary MRI
acromegaly management
i) transsphenoidal surgery
ii) octreotide if inoperable
- also dopamine agonists
acromegaly complications
diabetes
hypertension
cardiomyopathy
pseudogout
what is Addison’s
autoimmune adrenal gland destruction
presentation of Addison’s
hyperpigmentation
weakness
vomiting
weight loss
salt craving
electrolytes in Addison’s
hyponatraemia
hyperkalaemia
metabolic acidosis
hypoglycaemia
diagnostic test for Addison’s
short synACTHen test
how to investigate secondary hypocortisolism (low ACTH)
insulin induced hypoglycaemia
- normal should make ACTH
Addison’s management
- hydrocortisone + fludrocortisone
- sick day rules
a) double steroid if ill
b) inject hydrocortisone if unable to ingest
Addisonian crisis presentation
- collapse (hypoglycaemic)
- abdominal pain
- shock (hypotensive)
- vomiting
what are causes of hyperkalaemia classified by 5 systems
- Endo: Addison’s
- Metabolic: metabolic acidosis
- Drugs: ACEi, spironolactone
- Renal: CKD, AKI
- MSK: rhabdomyolysis
what are features of hyperkalaemia on an ECG
- bradycardia
- tall tented T waves
- wide QRS
- absent P wave
- prolonged PR
how to manage hyperkalaemia
i) cardiac monitor
ii) IV calcium gluconate 10%
iii) salbutamol nebs, insulin + dextrose
iv) loop diuretics, haemodialysis, calcium resonium
what is the role of calcium gluconate in hyperkalaemia
protects the heart
what is the role of salbutamol and insulin in hyperkalaemia
drive potassium into cells
what are causes of hypokalaemia classified by 3 systems
- Endo: Cushing’s, Conn’s
- Drugs: thiazides, loop diuretics
- GI: vomiting, diarrhoea
what are features of hypokalaemia on an ECG
- U waves
- small T waves
what are the 2 most common causes of hypercalcaemia
- primary hyperparathyroidism
- malignancy
what is sick euthyroid syndrome
- normal TSH
- low T4
what is subclinical hypothyroidism
- high TSH
- normal T4
- no symptoms
what are four causes of hypothyroidism
- Hashimoto’s
- subacute thyroiditis
- iodine deficiency
- drugs: amiodarone
what are symptoms of hypothyroidism
- lethargy, weight gain, cold intolerance
- menorrhagia
- diffuse goitre
what is an investigation for Hashimoto’s
- TFTs: high TSH, low T4
- anti TPO-antibodies
how do you manage hypothyroidism and what is one side effect
- levothyroxine
- osteoporosis
what are the 4 types of thyroid cancer
- papillary
- follicular
- medullary
- anaplastic
what are associations with papillary thyroid cancer
- young females
- radiation exposure
- spreads to lymph nodes
what are associations with follicular thyroid cancer
- older females
- iodine deficiency
what are associations with medullary thyroid cancer
- secretes calcitonin
- MEN-2
what are 3 features of thyroid cancer
- asymptomatic
- pressure symptoms: hoarse voice, dysphagia
- hard tethered nodule O/E
how would you investigate thyroid cancer
- normal TFTs
- US guided FNA
how do you manage thyroid cancer
i) thyroidectomy
ii) radioiodine ablation
iii) levothyroxine
what are three causes of thyrotoxicosis
- Graves
- subacute thyroiditis
- post partum thyroiditis
what are the stages of postpartum thyroiditis
- thyrotoxicosis (give propranolol)
- hypothyroidism
- euthyroid
what are three features from examination and investigation that point towards subacute thyroiditis
- painful goitre
- raised ESR
- zero uptake on iodine scan
what is the triad of symptoms specific for Graves
- exopthalmos
- pretibial myxoedema
- diffuse goitre
- acrophachy
what are features of hyperthyroidism
- tremour, heat intolerance, weight loss
- palpitations (AF)
- oligoamenorrhoea
how would you investigate thyrotoxicosis
- TFTs: low TSH, high T4
- anti-TSH antibodies for Graves
- iodine uptake scan if unsure increased in Graves
what is the management for Graves disease
i) propranolol for symptoms
ii) carbimazole
iii) radioiodine or thyroidectomy
what is an important side effect of carbimazole
- agranulocytosis
- careful for infections
what is an alternative for carbimazole used in pregnancy
propylthiouracil
what are two risks associated with a thyroidectomy
- damage to recurrent laryngeal nerve (hoarse voice)
- damage to parathyroid glands (hypocalcaemia)
what are 5 complications of thyrotoxicosis
- AF
- osteoporosis
- thyroid eye disease
- thyroid storm
- high output heart failure
what are the features of a thyroid storm
- fever, tachy, confusion, vomiting
- precipitated by surgery, infection
how do you manage a thyroid storm
- carbimazole + propranolol + hydrocortisone + potassium iodide
what is the most important risk factor for thyroid eye disease
smoking
what are the features of thyroid eye disease
- bilateral exopthalmos
- lid lag
- diplopia
how do you diagnose thyroid eye disease
- clinical
- orbital MRI
how do you manage thyroid eye disease
- lubricants
- steroids if severe
how do you manage subacute thyroiditis
NSAIDs
what is hyperosmolar hyperglycaemic state associated with
- T2DM
- older patients
how does hyperosmolar hyperglycaemic state happen
- hyperglycaemia
- glucose out through the kidneys
- water follows
- high serum osmolarity
what are 5 features of hyperosmolar hyperglycaemic state
- comes on over days
- dehydration, polyuria
- systemic: fatigue, vomiting
- altered consciousness
- hyperviscosity
what do you see in the bloods of hyperosmolar hyperglycaemic state
- FBC: hyperviscosity high platelets
- U&Es: hypernatraemia, high serum osmolarity
- hyperglycaemia
how do you calculate serum osmolarity
2Na + glucose + urea
how do you manage hyperosmolar hyperglycaemic state
i) IV fluids
ii) insulin if glucose still high
- VTE prophylaxis
how do you treat myxoedemic coma
IV thyroxine + hydrocortisone
