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
