Endo Flashcards
Prolactinoma
A benign pituitary adenoma that produces prolactin.
- Galactorrhea
- Menstrual irregularity
- Impotence (males)
- Headache, visual field abnormalities
Dopamine agonists to shrink tumour:
- Bromocriptine
- Quinagolide
- Cabergoline
Acromegaly
GH excess
1. Pituitary surgery + radiotherapy Dopamine agonist (cabergoline) Somatostatin analogue (octreotide) GH antagonist (pegvisomant)
Hypothyroidism
- Decreased thyroid hormone (T3/T4), apart from in subclinical.
- Decreased basal metabolic rate, decreased HR, fatigue, weight gain, lethargy, cold intolerance, amenorrhoea, menorrhagia
Primary: Overt: Inreased TSH, Decreased T4, Decreased/normal T3 Subclinical: Increased TSH, normal T3/T4 - Hashimoto's Thyroiditis - Iodine deficiency - Drug induced (Amiodarone/ lithium) Secondary: Decreased/normal TSH, Decreased T3/T4 - Pituitary/ Hypothalamus problem
Levothyroxine
- check TSH 4 weeks after starting then
- check TSH every 2 months
Hyperthyroidism
- Excess thyroid hormone (T3/ T4)
- Increased basal metabolic rate, increased HR, AF, anxiety, nervousness, weight loss, heat intolerance, tremor, diahorrhea, exopthalmos, thin hair, oligomenorrhea
- Graves Disease
- Nodular thyroid disease
Carbimazole (oral)
Propylthiouracil (If pregnant in 1st trimester)
Betablockers: Propranolol, for tremors
If relapsed/ presence of thyroid nodules: Radioactive iodine
Surgical excision
Graves Disease
Increased T3/T4, decreased TSH
A type of hyperthyroidism.
Autoimmune destruction of TSH receptors.
- smokers
- high iodine intake
- TSH receptor antibodies
- lid lag
- smooth symetrical goitre with homogenous iodine uptake
Carbimazole (oral)
Propylthiouracil (If pregnant in 1st trimester)
Betablockers: Propranolol, for tremors
If relapsed: Radioactive iodine
Nodular thyroid disease
Increased T3/T4, decreased TSH
Single nodule: toxic thyroid adenoma
Multiple nodules: toxic multinodular goitre
Carbimazole (oral)
Propylthiouracil (If pregnant in 1st trimester)
Betablockers: Propranolol, for tremors
If relapsed/ presence of thyroid nodules: Radioactive iodine
Surgical excision
De Quevrain’s (subacute) thyroiditis
T4: increases, then decreases, then normal
TSH: decreases, then increases, then normal
Expresses symptoms of thyrotoxicosis
- Viral trigger (previous sore throat)
- Tender goitre
Self limiting
NSAIDS
Beta blockers: propranolol
Aspirin
Hypercalcaemia
Excess of Calcium
- Usually due to hyperparathyroidism/ cancer
“Stones, bones, groans, and phychic moans”
- Thirst, dehydration, confusion, polyuria
- Osteopenia, fractures, depression
- Abdominal pain, pancreatitis, ulcers, renal stones
Fluids: 0.9% saline 4-6L in 24h Loop diuretics (if rehydrated) Biphosphonates (lower Ca2+) Calcitronin salmon If myeloma: Chemotherapy
Primary Hyperparathyroidism : overproduction of PTH (eg: adenoma)
Increased PTH and Ca2+
Surgery to remove adenoma
Secondary Hyperparathyroidism : Physiological response to low Ca2+
Increased PTH, decreased Ca2+
Treat underlying cause (renal failure etc)
Tertiary Hyperparathyroidism : Excessive PTH production after years of secondary. PT is autonomous.
Increased PTH and Ca2+
Cinacalcet
Hypocalcaemia
Due to: hypoparathyroidism, Vit D deficiency, chronic renal failure
Calcium supplements
Vit D tablets
6 monthly injection of cholecalcifol
Osteoporosis
Calcium and Vit D supplements Biphosphonates Denosumab Teriparatide HRT Selective Oestrogen Receptor Modulator Testosterone
Type 1 Diabetes Mellitus
Immune system destorys beta cells in the pancreas. The body can sense sugar levels, however cannot produce insulin.
- Weight loss, polyuria, polydipsia, fatigue, blurred vision
- Candida infetion
- DKA presentation
Insulin
Blood sugar monitoring
Education: Carb estimations etc
Type 2 Diabetes Mellitus
Hyperinsulinaemia, insulin resistance and relative insulin deficiency
- Diet and exercise
- Metformin
- Metformin + Sulphonylurea
Metformin + TZD
Metformin + DDP IV - Metformin + Sulphonylurea + TZD
Metformin + GLP-1
Metformin + Sulphonylurea + GLP-1 - Metformin + Sulphonylurea + Insulin (basal isophane, humulin/ insulatard)
Diabetic Ketoacidosis
Ketonaemia> 3mmol/l / >2++ on urinalysis
Blood glucose > 11mol/l
Bicarbonate <15mmol/l / venous pH <7.3
- Vomiting, abdominal pain, kussells’ breaths, weakness, confusion
A decrease in insulin, leads to an increase in glucagon which increases glucose (released from the liver). High glucose in the urine leads to ometic diuresis.
The absence of insulin leads to lipolysis which leads to fatty acids being converted through beta oxidation into ketone bodies that make the body more acidic.
0.9% saline 500ml stat
replace missing electrolytes
insulin (0.1 units/kg/per)
Hyperosmolar hyperglycaemic State (HSS)
High glucose in blood, absence of ketones/ acidosis
- due to thiazides, steroids, fizzy drinks
- Common in elderly
- Blood glucose > 60mmol/l
- dehydration, weakness/cramps, confusion
0.45% saline
insulin
LMWH prophylaxis
Hypoglycaemia
Glucose level: <3.9 mmol/l
- Shakiness, anxiety, tachycardia, sweating, cold, clammy, dilated pupils, nausea, fatigue, confusion
Acute: glucose tablet/ gel
Afterwards: biscuits/snack if still a while till next meal
Severe: glucagon injection
Primary Adrenal Insufficency
Inadequate adrenocorticoid function due to:
- Addison’s disease
- Congenital adrenal hyperplasia
- Adrenal TB, malignancy
- Weight loss, fatigue, low BP, abdominal pain, vomiting, skin pigmentation
Hydrocortisone (mimics diurnal cortisone rhythm)
Fludricortisone (replaces aldosterone)
Education
Secondary Adrenal Insufficency
Inadequate adrenocorticoid function due to:
- Lack of ACTH stimulation
- Iatrogenic (excess exogenes steroid)
- Hypothalamic/ pituitary disorders
- Weight loss, fatigue, low BP, abdominal pain, vomiting
Hydrocortisone
Addison’s disease
Immunological destruction of the adrenal cortex
- Weight loss, fatigue, low BP, abdominal pain, vomiting, skin pigmentation
Hydrocortisone (mimics diurnal cortisone rhythm)
Fludricortisone (replaces aldosterone)
Education
Addisonian Crisis
Medical emergency caused by insufficient levels of cortisol
Penetrating pain in the legs, severe vomiting and diahorrea, low BP, fever, confusion, syncope, convulsions, lethargy
- Hyperkalaemia
- Hypercalcaemia
- Hyponatraemia
Injected hydrocotrisone (long-term) If stopping- wean off
Cushing’s Syndrome
Excess cortisol secretion
- Women 20s-40s
- Moonface with red plethoric cheeks
- Cataracts, buffalo lump, abdominal fat
- Easily bruised, poor wound healing
- Muscle wasting (thin legs)
- Striae, HTN, myopathy
ACTH dependent: - pituitary adenoma - ectopic ACTH production (carcinoma) ACTH independent: - adrenal adenoma, carcinoma, hyperplasia
Adrenalectomy
Metyrapone
Ketoconazole
Pasireotide
Cushing’s Disease
A pituitary problem leading to over production of ACTH
Hypophysectomy (surgical removal of the hypophysis (pituitary gland))
Radiotherapy
Bilateral adrenalectomy
Primary Aldosteronism
Autonomous production of aldosterone independant of its regulators (Angiotensin II/ K+). Due to:
- Bilateral adrenal hyperplasia
- Conn’s syndrome
- Severe HTN, hypokalaemia, alkalosis
Spironolactone, epleronone (Mineralcorticoid receptor agonists)
Laparoscopic adrenalectomy
Pheochromocytoma
Adrenaline secreting tumour of the adrenal glands
- associated with headaches, palpitations, sweating and HTN
The 10% tumour:
- malignant
- bilateral
- hyperglycaemia
- in children
- familial
- associated with MEN2
Phenoxybenzamide (alpha-blocker) Atenolol, propranolol, metoprolol (beta-blockers) Fluid replacement Remove laparoscopicaly Chemotherapy
Polycystic ovarian syndrome (PCOS)
Elevated endrogens in females
- oligomenorrhea, menorhaggia, amenorhea
- excess hair, pelvic pain, darker thickened skin
- infertility
Folic acid, rubella vaccination,
Weight loss
Metformin
Contraceptive pill
Ovulation induction:
- Clomiphene citrate
- Gonadotrophic injections
Maturity onset diabetes of the young (MODY)
- defective glucose sensing in pancreas
- loss of insulin secretion
- strong family history
- C-peptides positive
Gibenclamide
Donohue Syndrome
- Look like an elf/ leprechaun
- Autosomal recessive
- Growth retardation
- Severe insulin resistance due to insulin receptor signalling
Support
Carb meals + large insulin bolus
Life expectancy <2 years
Rabson Mendenhall Syndrome
- autosomal recessive
- severe insulin resistance
- hyperglycaemia, compensating hyperinsulaemia
- acanthosis nigricans
- DKA
- fasting hypoglycaemia
Support
Carb meals + large insulin bolus
Life expectancy <2 years
Wolfram Syndrome / DIDMOAD
- Diabetes insipidus
- Diabetes mellitus
- Optic atrophy
- Deafness
Treat symptoms systematically
Bordet-Biedl Syndrome
-obesity, retinitis pigmentosa, polydactyly, hypogonadism, and renal failure
Treat symptoms systematically
Diabetic Nephropathy
- Kimmelsteil-wilson syndrome/ Nodular glomerulosclerosis
- microvascular changes that lead to angiopathy of capillaries in the kidneys
- HTN
- Decreased GFR
- Increased Vascular disease
ACE inhibitors
ARBs
Decrease blood pressure to <130/80 if
Neuropathy
Amytriptyline Duloxetine Gabapentin Pregabalin Topical capsaicin cream
Obesity
Orlistat
Bariatric Surgery
Thyroid Storm
- severe hyperthyroidism
- resp + cardio failure
- medical emergency
Lugol's iodine Glucocorticosteroids Propylthiouracil Beta-blockers Fluids + monitoring
Diabetes Insipidus
- lack of ADH
- life-threatening dehydration
Desmospray
Desmopressin oral tablets
Desmopressin injection
Syndrome of inappropriate ADH secretion (SIADH)
- ectopic production of ADH
Treat underlying cause
Demeclocycline
Conivaptan
Tolvaptan
Craniopharyngioma
rare type of brain tumor derived from pituitary gland embryonic tissue that occurs most commonly in children
- Headaches and visual disturbances
Radiotherapy
Panhypopituitarism
A decrease in production of anterior pituitary hormones
- GH insufficiency
- Hypothyroidism
- Hypogonadism
- Adrenal insufficiency
Due to: tumours, granulomas, trauma
Thyroxine Hydrocortisone ADH GH HRT/oestrogen/progesterone (female) Testosterone (male)
Congenital Adrenal Hyperplasia
Excessive/ deficient production of sex steroids
- autosomal recessive
Males: adrenal insufficiency, weight gain
Females: Genital ambiguity
Glucocorticoid replacement
Surgical correction
Restore fertility
Hypothalamic ovulatory disorder Type 1
Due to: stress, excessive exercise, Kallman’s syndrome, decreased FSH, decreased oestrogen
Stabilise weight
Hormone therapy:
- GnRH
- FSH and LH
Hyperprolactinaemia
- Galactorea
- Amenorrhea
Normal FSH/LH, decreased oestrogen, increased prolactin
Dopamine agonist (cabergoline) Bromocriptine
Premature Ovarian Failure
Menopause <40 years old
Increased FSH, decreased oestrogen
- Amenorrhoea
- Associated with Turner’s, Fragile X, Addison’s
HRT
egg donation
Hypogonadism (male)
Primary: Congenital
- Decreased testosterone, increased LH/FSH
Secondary: Pituitary/hypothalamic
- Decreased testosterone and LH/FSH
Testosterone
Turner syndrome
- one women (one X chromosome)
- short stature
- failure to pass through puberty
webbed neck, spaced nipples, shield chest - coarctation of the aorta
- lymphoma, scoliosis
Treat symptoms
Gestational diabetes
A woman without diabetes develops high blood sugar levels during pregnancy. Gestational diabetes generally results in few symptoms; however, it does increase the risk of pre-eclampsia, depression, and requiring a Caesarean section
Lifestyle
Metformin
Insulin
