Endo Flashcards
Causes of a diffuse goitre
Idiopathic
Puberty, pregnancy and postpartum
Graves’ disease
Thyroiditis - Hashimotos, subacute thyroiditis
Iodine deficiency
Goitrogens - iodine excess, drugs - lithium
Inborn errors of thyroid hormone synthesis - Pendred’s syndrome
Causes of thyrotoxicosis
Primary: Graves Toxic adenoma or multinodular goitre Hashimoto’s thyroiditis Subacute thyroiditis Iodine induced Excess thyroid hormone replacement Postpartum thyroiditis Drugs - amiodarone
Secondary:
Pituitary or ectopic thyroid- stimulating hormone hypersecretion
Hydatidiform mole
Struma ovarii
Causes of hypothyroidism
Primary: Without a goitre: Idiopathic atrophy Treatment (radioiodine, surgery) Agenesis or a lingual thyroid Unresponsiveness to TSH
With a goitre: Chronic thyroiditis Drugs (amiodarone, lithium) Endemic iodine deficiency Iodine-induced hypothyroidism Inborn errors
Secondary
Pituitary lesions
Tertiary
Hypothalamic lesions
Transient
Thyroid hormone treatment withdrawn
Subacute thyroiditis
Postpartum thyroiditis
Signs of Acromegaly disease activity
SSHHEGG
Skin tag number
Sweating excessively
HTN
Headache Symptoms + Increasing ring size, shoe size, and dentures
Eyes (Increasing visual field loss or development of CN pathology (3,4,5,6))
Goitre enlarging
Glycosuria
Diagnosis of Acromegaly
Biochemical
-Increased IGF-1 in plasma with no suppression in a glucose tolerance test or a paradoxical rise in GH
Anatomical
- Skull XR film
- MRI B for pituitary adenoma
Causes of Acromegaly
Pituitary adenoma
Ectopic production of growth hormone releasing hormone
Ectopic production of GH (Hypothalamic, carcinoid, and pancreatic tumors)
Cushings Screening tests
Cortisol levels in morning and evening
24 hour urinary free cortisol (positive test is 3 fold increase above normal)
Overnight Dexamethasone suppression test
FBE (For secondary polycythemia, neutrophilia, and eosinopenia)
UEC for electrolytes
BSLs for hyperglycemia
Definitive tests for Cushings
- Low dose Dexamethasone suppression test
- High dose Dexamethasone suppression test (Cushings Syndrome has no suppression, but Cushings disease will suppress)
- ACTH level (High in ectopic production and Cushings disease; Low in adrenal cause of Cushings Syndrome)
- Petrosal Sinus ACTH levels
Autoimmune associated disease
Addisons Hypoparathyroidism Mucocutaneous candidiasis T1DM Hashimotos Graves Primary ovarian failure Pernicious anaemia Vitiligo Alopecia Hypophysitis Myasthenia gravis
Features of Autonomic neuropathy
- Postural Hypotension
- Loss of sinus arrhythmia
- Valsalva manoeuvre causes no slowing of the pulse
- Loss of sweating
- Erectile dysfunction
- Nocturnal diarrhea
- Urinary retention and incontinence
Signs of diabetic retinopathy
Nonproliferative
- Dot haemorrhages
- Blot haemorrhages
- Hard and soft exudates
- Microanuerysms
- Dilated veins
Proliferative
- New vessels
- Vitreous hemorrhage
- Scar formation
- Retinal detachment
- Laser scars