endo Flashcards
cushings bloods
hypokalaemic metabolic alkalosis
cushings Ix
1st line overnight low dose dexamthasone suppression test
= if cushings -> morning cortisol spike not suppressed
and high dose dex suppresion
2x 24hr urine free cortisol
2x bedtime salivary cortisol
high dose dex supression cortisol not suppressed but ACTH supressed
cushing syndrome due to other cuase (not pitruatry) ie adrenal adenoma
high dose dex supression
cortisol suppressed
ACTH supressed
cushings disease ie pit adenoma –>ACTH secretion
high dose dex supression
cortisol not suppressed
ACTH not supressed
ectopic ACTH syndrome
differentiate between cushings and pseudo cushings
insulin stress test
how to differentiate between pitruatry and ecotpic ACTh secretion
petrosal sinus sampling of ACTH
addisons acid base
hyperkalaemic metabolic acidosi
graves antibodies
TSH receptor
Anti tpo antibodies
hashimotos thyroiditis
acromegaly what is it
hypersectrion of GH usually from ant pit tumor
signs and sx of acromeg
bi temp hemanopia
headache
teeth spacing
frontal bossing
macro tongue
sweating
ddx acromegaly
SERUM IGF1
ogtt -> (hyperglycaemia should supress GH) but doesnt in acro
what else to screen for with acromegaly
diabetes bc GH is anti insulin = insulin resistance
what do acromegaly pts usually die of
CVD
acromegaly tx
transphenoidal resection
somatostatin analogue -octreotide
pegvisomant
bromocriptine
causes of hypothyroid
amiodarone
radiotherapy
iodine def
ca
infection
hypopitrutary
thyroid embryological origin
foramen caecum
hypothyroid asscoiated diseases
pernicous anaemia
vitiligo
graves tx
carbimazole
propythiouracil
radioidione
4Cs moniter DM
control glycaemic
competency w meds
complicatons
coping
kussmauls breathing
DKA
whipples triad
hypogycaemia
low plasma glucose <3
sx of hypo
relief w glucose
autonomic hypo sx
sweating
tremor
palp
anxiety
neurogylcopenic sx hypo
confusion
drowseiness
seizure
coma
personality change
fnd
causes of hypo
insulin,sulfonurea in prev knwon diabetic
pit insuff
liver failure
addisons
exogenous drugs
high insulin hypoglycaemia causes
increased c peptide
sulphon
high insulin hypoglycaemia causes
normal c pep
insulin
low insulin high ketones hypogly
alocohol w no food
pit insuff
addisons
low insulin now ketones hypoglycaemia cause
non pac neoplams
insulin receptor abs
post prandial hypoglycaemia
dumping post gastric bypass
mc hypothyroid uk
atrophic thyroiditis
atrophic thyroiditis
ABs
goitre?
associations
anti tpo anti tsh
lymphocytic infiltration = no goitre
pernicous anaemia
vitiligo
endocrinopathies
hashimotos
abs
path
anti TPO
atrophy+ regen =goitre
myxeoedema coma
looks hypothyroid
hypoglycarmia
hypothyroid
heart failure (brady n red BP)
coma and seizures
causes of myxedema coma
radioiodine
thyroidectomy
pit surgery
infection, trauma, MI, stroke
types of mailigant thyroid disease
papillary
follicular
medullary
anaplastic
lymphoma
thyroid surg sx
reactionary haematoma (remove clips and call anaesthetist)
laryngeal oedma
recurrent laryngel palsy
hypoparathyroid
hyperparathyroid presentation
inc Calcium
Stones bones moans and groans
renal stones, polyuria and polydipsia
bone pain, pathological fracture
deoression
abdo pain, N&V, constipation, pancreatitis, PUD (in gastrin)
and in BP
primary hyperPTH causes and ix
solitary adenoma mc
bloods- ^ca, ^/N pth, ^alp, dec PO4
ECG
XR - phalyngeal erosions
DEXA osteoporosis
primary hyperpth tx
inc fluid intake
avoid diet ca and thiazides
excision of adenoma
2ndry hyper pth causes
and bloods
vit d deficiency
chronic renal failure
2ndy hyper pth bloods
inc PTH
red Ca
inc po4
inc ALP
red vit D
hypoparathyroid presentaton
Presentation: low Ca
SPASMODIC
Spasms (carpopedal = Trousseau’s sign)
Perioral paraesthesia
Anxious, irritable
Seizures
Muscle tone inc - colic, wheeze, dysphagia
Orientation impaired (confusion)
Dermatitis
Impetigo herpetiformis (low Ca + pustules in pregnancy)
Chovsteks, cardiomyopathy (1 QTc - TdP)
trousseus sign
chovsteks sign
hypoparathyrid
HAND SPAZ ON BP CUFF
touch infront ear = facial nerve twtiching
bloos hypopth
low ca
high phosphate
low pth
normal ALP
causes of cushings syndroms that wont respond to dex supression
ACTH independant causes ie steroids or adrenal adenoma
ACTH depedant
ectopic ACTH from SCLC, carcinoid
only cushings syndroms responds to high dose dex
cause bilat adrenal hyperplasia from acth pitruit tumor
cushings disease tx
transphenoidal excision
ectopic acth
metyrapone
adrenal ademona/ca cushings tx
adrenalectomy
nelsons syndrome
rapid enlargement pit adeona post bilat adrenalectomy for cushings syndrome
pt
bitemp hempanp
hyperpigmentation
primary hyper adolest path
pt
excess aldoesterone independant of RAS
hypokal
parathesia
inc BP
causes of 2ndry hyperaldoes
and ix
due to inc renin bc renal hypoperf
RAS
diuretics
CCF
hepatuc failure
nephrotic
normal aldoesterone renin ratio
addisons bloods
low na
high k
low glucose
low ca
anaemia
pheochromacytoma path and causes
catecholamine producing tumor usually in adrenal medulla
RULE of 10s
10% malignant
10 extra adrenal
10 bilateral
10 part of hereditory syndrome
hyperprolactineamia causes
exces production ie
- preg, breastfeedins
- prolactinoma
- hypothyroi(inc TSH)
dishib bc compression of pit stalk
-pit edenoma
- craniopharyngioma
Dopamine antagonists (MC)
- metoclopromide
- risperdione, halopeid
hyperprolactinaemia tx
1st cabergoline,bromocriptine
2nd transphenoidl excision
acromegaly ca risk
inc risk colon polyps which may develop to colon ca
acromegaly tx
1st line: trans-sphenoidal excision
2nd: somatostatin analogues - octreotide
3rd line: GH antagonist - pegvisomant
4th line: radiotherapy
Diabetis inspid urine
exclude DI if
urine: plasma osmolality >2
diab inspid Dx
water dep test with desmopression trial
causes of hirsutism
pcos
cushings
adrenal ca
steroids
causes og gynacomastea
cirhossis
hypogonadism
hyperthyroid
oest/hcg producing tumor ie testicular
drugs = spiro digoxin oestrogen
dka path
insulin def = glucose prod in liver
lipolysis also occurs -> fatty acids broken down form ketone bodies
= met acidosis
why abdo pain in dka
polyuria 2ndry to glucose induced osmotic duiresis = dehydration
why k infusion in dka
insulin causes rapid uptake of k into cells
addisons
low na
high k
low glucose
prolactinoma sx
amenorhea
infert
galactorhea
dec libido
prolactinoma tx
transphen resection
radiotherapy (may cayse hypopit)
dop agonst = cabergoline, bromocriptine(if want preg)
causes of hypophos
refeeding
glucose infusion
alcoholism
renal tubular leak
resp alkalosis of any cause
causes hyperphos
tumor lysis
rhabdo
renal fail
excess vit D or phos containg med
vit D and ca relation
vit d needed to absorb ca in gut
neuropathic complications of DM
symmetric sensory poly - glove and stocking
mononeuropath ie CN3/6 palsy
femoral neuropathy
autonomic neuropaty
diabetic foot signs
absent pulses
ulcers painless pucnhed out
charcots joint
claw toe
pes cavus
bad controlled dm starts vomiting intractibly
gastric paresis
