Endo conditions Flashcards
What symptoms will someone with Addison’s disease classically present with?
Hyperpigmentation Lethargy Anorexia Weight loss Nausea/vomitting Hypotension
How does Addison’s disease arise?
Adrenocortical failure due to destruction of the adrenal cortex which results in a lack of aldosterone, cortisol and DHEA
Which 3 hormones are not produced in Addison’s disease?
Cortisol
Aldosterone
DHEA
What is the first line investigation for Addison’s disease?
Synacthen test which is when a synthetic version of ACTH is given and cortisol levels are measured half an hour before and after- if they aren’t raised after then it is likely the patient has Addison’s
What investigations would you do if you suspect someone has Addison’s disease?
Synacthen test
Electrolytes
FBC
What investigations would you do if you suspect someone has Addison’s disease?
Synacthen test
Electrolytes
FBC
What electrolyte imbalance is someone with Addison’s likely to have?
Hyponatraemia
Hyperkalemia
How is Addison’s disease managed?
Cortisol replacement- hydrocortisone or prednisolone
Aldosterone replacement- fludrocortisone
DHEA replacement if low libido or lethargy
What class of hormones is cortisol?
Glucocorticoids
What class of hormones is aldosterone?
Mineralocorticoids
What are the main complications of Addison’s disease?
Secondary Cushing’s syndrome
Osteopenia/osteoporosis (from prednisolone)
What symptoms will someone with hypoglycaemia present with classically?
Diaphoresis Tremor Confusion Hunger Anxiety Tingling Nausea Drowsiness Blurred vision
What are some common causes of hypoglycaemia?
Incorrect insulin usage
Insulinoma
How is hypoglycaemia managed?
If they are conscious and able to swallow give them fast acting carbohydrates eg glucose gel, glucose pills etc and then after a while long acting carbs eg a slice of bread
If they cannot swallow or are unconscious give IM glucagon
What symptoms will someone with Cushing’s disease classically present with?
Weight gain Facial rounding Striae Hyperglycaemia Hypertension Menstrual irregularity
How does Cushing’s disease arise?
Any pathological cause of hypercortisolism eg pituitary tumour, tumour of the adrenals
What are the 2 types of Cushing’s disease? What is the difference in pathophysiology?
ACTH dependent- higher levels of ACTH lead to higher levels of cortisol
ACTH independent- high levels of cortisol but normal/low levels of ACTH
Who is most likely to get Cushing’s disease?
Women
People on glucocorticoids
What are some common causes of Cushing’s disease?
Pituitary tumor
Adrenal tumor
Exogenous steroid use
What is the difference between Cushing’s disease vs Cushing’s syndrome?
Cushing’s disease= pituitary tumor leading to excess cortisol (due to excess ACTH)
Cushing’s syndrome= any pathological reason for hypercortisolism
What symptoms will someone with hyperthyroidism present with classcially?
Heat intolerance Fatigue Weakness Palpitations Tremor Weight loss (unexplained and non intentional) Anxiety Diarrhoea Oligomenorhea Orbitopathy if its due to Grave's
Who is more likely to present with hyperthyroidism?
Those with family history
Females
How is hyperthyroidism investigated?
TSH is measured (usually it will be low)
If its high or normal measure FT4
If its low measure FT4 and FT3
What are some causes of hyperthyroidism? Explain the hormone levels in each one
Grave’s disease= autoimmune disease where antibodies stimulate TSH receptors on the thyroid gland, low TSH, high FT3 and FT4
Pituitary tumor= tumor of the pituitary secretes TSH and raises thyroid hormone levels, high TSH, high FT4 and FT3
Thyroid nodule= nodule of the thyroid is overactive resulting in high FT4 and FT3 but low TSH
Thyroiditis= inflammation of the whole thyroid gland resulting in high FT4 and FT3 but low TSH
How is hyperthyroidism managed?
Anti thyroid drugs eg carbimazole, thiamizole
Radioiodine therapy where the thyroid cells are damaged to stop them making excess hormones
Surgery to remove part or all of the thyroid
What are complications of hyperthyroidism?
Thyroid storm
Problems in pregnancy eg pre eclampsia, miscarriage
Eye problems
What are the first line investigations you shoudl order if you think someone has hyperthyroidism?
Serum TSH
Can also measure FT4 and T3
What symptoms will someone with hypothyroidisim present with classically?
Fatigue Weight gain Depression Cold intolerance Constipation
What are the first line investigations when you suspect someone has hypothyroidism?
Serum TSH (will be high)
Can also measure FT4 and T3
FBC (check for anaemia)
Cholesterol (check due to weight gain)
How is hypothyroidism managed?
Levothyroxine
If they are young measure their TSH and FT4 to monitor them
How long does treatment for hypothyroidism take to work?
It can take up to 6 months for TSH levels to return to normal
What is the difference between primary and secondary hypothyroidism and how do hormone levels differ?
Primary= thyroid gland doesn't make enough T4 and T3, this causes high TSH levels Secondary= TSH levels are low which insufficient T3 and T4 production from the thyroid
What is Hashimoto’s thyroiditis?
Autoimmune hyperthyroidism
What are hormone levels over the course of Hashimoto’s thryoiditis?
Hyperthyroidism to start with (inflammation of the thyroid)
Hypothyroidism following this due to thyroid cells unable to take in iodine
Normal thyroid levels
Are thyroid gland lumps deep or surperficial?
Deep
What does diffuse and smooth enlargement of the thyroid indicate?
Hashitmoto’s, Grave’s physiologoica goitre
What can you ask the patient to do to try and ascertain if the nodule is on the thyroid? What will you see?
Get them to swallow, the nodule will move
What can you ask the patient to do to try and ascertain if the nodule is a thyroglossal cyst? What will you see?
Tell them to stick their tongue out and it will move when they do this
What are hand signs of hyperthyroidism?
Fine tremor Palmer erythema Clubbing Sweating Tachycardia Onycholysis
What is onycholysis?
Separation of the nail from the nail bed
What are eye signs in hyperthyroidism?
Lid lag
Exopthalamos
What signs are specific to Grave’s disease?
Exopthalamos
Pretibial myxoedema
What are some general signs of hypothyroidism?
Deepening or voice
Coarse skin
Oedematous looking face
Slow reflexes
What will thyroid levels be in someone with goitre?
You can’t tell you have to test them biochemically
They could be hypo hyper or euthyroid
What are thyroid levels in someone with malignancy/
They can be anything, most commonly they are euthyroid
What antibody is tested if someone has high TSH? Why?
Thyroid peroxidase antibody to check for Hashimoto’s thyroiditis
If someone has a neck lump and thyroid function is measured, who should they be reffered to if thyroid levels aren’t normal vs are normal
Normal= surgeon as it could be malignant (such patients are often euthyroid) Deranged= endocrinologist (thyroid issue that likely isn't to do with malignancy)
What is thyroid eye disease?
Changes to the orbital tissue due to thyroid dysregulation
What are some classical symptoms of thyroid eye disease?
Soreness of the eyes Bulging out of the eyes (exopthalamos) Diplopia Increased watering of the eye Visual problems due to compression of the optic nerve
What thyroid problems cause thyroid eye disease?
Hyperthyroidism (Grave’s disease)
How is thyroid eye disease managed?
Conservative management is ideal
If severe, corticosteroids may eb prescribed first
Radiation therapy can be used to reduce inflammation at the back of the eye
Surgery can be used for decompression if the optic nerve is compromised
What is the pathophysiology of thyroid eye disease?
Thyroid dysregulation causes the eye muscles to enlarge and fatty tissue to build up behind the eyes
What is a notable side effect of medications for hyperthyroidism that you must warn patients about?
Agranulocytosis- this means their immune system may not be as strong so they are more at risk of infections etc
What is diabetes insipidus?
A metabolic disorder where there is inability to concentrate urine due to either lack of AVP production or insensitivity to AVP by renal cells