Endo - symptoms + signs Flashcards
Symptoms of DI
- Chronic thirst
- Polyuria (3L/24h)
- Nocturia
- Signs of hypernatraemia
Lethargy, restlessness, irritability, hyper-reflexia, spasticity, muscle twitching
Severe: delirium, seizures, coma - Incontinence (if damage to the bladder through over-distention)
Signs of DI
- Hypernatraemia
- Hypotonic urine
- Distended and palpable bladder
- 24h urine collection - urine volume >3L
- Signs of volume depletion - dry mucous membranes, reduced skin turgor, tachycardia, hypotension, narrow pulse pressure
Symptoms and signs of hypocalcaemia
CATs go numb
Convulsions
Arrhythmias (prolonged QT)
Tetany
Paraesthesia (hands, mouth, feet, lips)
Trousseau’s sign
Chvostek’s sign
Prolonged QT
Hyperreflexia
Stridor
Hypocalcaemia is a result of pancreatitis, renal failure
Sympotms and signs of hypercalcaemia
Stones, throans, bones, groanes, psychiatric overtones
Renal stones Bone pain/damage Polyuria Abdo upset (constipation, nausea, pain) Psychiatric conditions (depression, anxiety)
Hypercalcaemia can also cause pancreatitis
Symptoms and signs of primary hyperparathyroidism
Symptoms of hypercalcaemia
• Excess calcium makes neurones less excitable
o Slower muscle contractions
o Diminished neuro firing in the CNS
• Hypercalciuria – can lead to dehydration
Stones, thrones, bones, abdo groans, psychic overtones
• Stones – renal colic, kidney stones, gallstones
- Thrones – refers to the toilet – polyuria, polydypsia dehydration
- Bones – bone pain, osteopenia, osteoporosis, pathological fractures
- Groans – constipation, muscle weakness, proximal myopathy, fatigue
- Psychic overtones – depression, dementia, confusion, inability to concentrate, memory problems
Symptoms and signs of secondary hyperparathyroidism
- Signs + symptoms of CKD
- Fractures/bone pain
- Renal osteodystrophy – bone resorption
- Rickets (bone bossing, rachitic rosary, bowed legs, knock knees)
- Proximal myopathy
- Fatigue
- Hypocalcaemia – CATs go numb
• Calcification in blood vessels and soft tissues (high levels of phosphate cause it to find and stick to any available calcium, which forms bone-like crystals in places that thy shouldn’t be)
Secondary hyperparathyroidism is basically
• Vitamin D deficiecy
• Osteomalacia
• Rickets
Paget’s disease symptoms + signs
• Misshapen bones can cause nerve impingement
o Pain
o Hearing loss (impingement of the auditory nerve)
o Vision loss (impingement of the optic nerve)
o Lower limb muscle weakness (misshapen vertebrae compress the spinal cord)
o Sciatica
o Spinal stenosis
• Bony deformities o Leontiasis (bitemporal skull enlargement with frontal bossing) o Increasing skull size o Bone bossing (skull, femur, tibia) o Paget’s sarcoma (osteosarcoma) o Kyphosis o Pelvic asymmetry o Bowing of femur, tibia, forearm o Prognathism o Osteoarthritis o Pathological fractures
- Bone pain aggravated by movement (femur, pelvis, skull)
- Increased local temperature (skin over involved bone may be warm) – due to increased vascularity + metabolic activity
Symptoms + signs of osteoporosis
• Asymptomatic until fracture occurs
• Signs of vertebral fractures (most common fractures in osteoporosis) o Back pain o Loss of height o Kyphosis o Tenderness on percussion
• Sign of femoral neck fracture (commonly after minimal trauma)
o Severe pain with leg shortened and externally rotated
• Colles’ fracture of the distal radius after fall onto outstretched hand
Symptoms and signs of tertiary hyperparathyroidism
• Stones, thrones, bones, groans, psychic overtones
• Excess calcium makes neurones less excitable
o Slower muscle contractions
o Diminished neuro firing in the CNS
• Hypercalciuria – can lead to dehydration
Stones, thrones, bones, abdo groans, psychic overtones
• Stones – renal colic, kidney stones, gallstones
- Thrones – refers to the toilet – polyuria, polydypsia dehydration
- Bones – bone pain, osteopenia, osteoporosis, pathological fractures
- Groans – constipation, muscle weakness, proximal myopathy, fatigue
- Psychic overtones – depression, dementia, confusion, inability to concentrate, memory problems
• Calcification in blood vessels and soft tissues (high levels of phosphate cause it to find and stick to any available calcium, which forms bone-like crystals in places that thy shouldn’t be)
if tertiary hyperparathyroidism due to CKD - high phosphate
if tertiary hyperparathyroidism due to chronic vitamin D deficiency or if renal transplant - low phosphate
Signs of hypothyroidism on physical examnation
Hands
Bradycardia
Cold
Head/Neck/Skin Goitre Puffy face Oedema Hair loss Dry skin Vitiligo
Chest
Pericardial or pleural effusions
Abdomen
Ascites
Neuro
Delayed relaxation of reflexes
Carpal tunnel syndrome
Features specific to Grave’s disease (graves triad)
Ophthalmopathy (exophthlamos, periorbital oedema, increased tear production, blurred vision, ophthalmoplegia, double vision due to extraocular muscle weakness) Pretibial myxoedema (non pitting) Thyroid acropathy (resembles clubbing)
Other Proximal myopathy (thyrotoxic myopathy, hyperthyroid myopathy) Hyperreflexia Lid retraction + lid lag Tachycardia + AF Thyroid gland - audible bruit Presence of bruit
Thyroid crisis symptoms and signs
> 2 feature - at risk of death, need aggressive treatment
- Hyperpyrexia (>41)
- Severe Tachycardia (>170)
- Cardiac failure
- Hepatocellular dysfunction
- Jaundice
- Psyciatric symptoms (anxiety, delirium, psychosis)
Coma
What is myxoedema coma?
Sympotms + signs
mx
Severe form of hypothyroidism that happens in the elderly
- Heart failure
- Hypotension
- Hypothermia
- Hyponatraemia
- Hypoxia
- Hypercapnia
- Confusion
- Coma
Mx
- IV hydrocortisone (if secondary hypothyroidism due to hypopituitarism) **
- IV T3
- Supportive measures - oxygen, rewarming, IVF
- Treatment of underlying cause (e.g. infection)
- Replace T3 with T4 after 2-3 days if there is clinical improvement
- always give hydrocortisone before thyroid hormone, always assume that hypothyrodidism is due to hypopituitarism until TFTs arrive, because hydrocortisone deficiency can kill
In very general terms, how does DM present?
Polyuria
Polydipsia
Triad of signs in SIADH
Triad of
- Hypotonic hyponatraemia
- Concentrated urine
- Euvolaemic state (therefore BP normal!)
Signs and symptoms of acormegaly/GH/excess growth hormone
- Increased sweating
- Prognathism, macroglossia, enlarged nose, frontal bossing
- Organomegaly
- HTN
- Carpal tunnel
- Sleep apnoea (bc of macroglossia)
- Insulin resistance (GH increases HGO)
- Headaches
- Bitemporal hemianopoia
MEN1
- Pituitary adenoma
- Parathyroid adenoma
- Pancreatic tumours
(+ Facial angiofibromas, Collagenomas, Meningiomas)
• Parathyroid adenoma is the most common
o Stones, thrones, bones, groans, psych overtones
• Pancreatic tumours
o Gastrinomas - Zollinger- Ellison syndrome - Increased gastrin - increased HCl production - peptic ulcers, abdominal pain, vomiting
o Insulinomas - Whipple’s triad - 1) symptoms of hypoglycaemia (hunger, dizziness), 2) low glucose levels at the time of the symptoms, 3) Relief of symptoms when glucose is given
o Glucagonomas - hyperglycaemia
o Somatostinomas - hyperglycaemia (somatostatin inhibits insulin production)
o Vipomas - secretion of vasointestinal active peptide - watery diarrhoea - dehydration, metabolic acidosis, hypokalaemia
• Pituitary adenomas
o Hyperprolactinemia - galactorrhoea, gynecomastia
o XS GH - gigantism (children), acromegaly (adults)
• Facial angiofibromas
o Benign tumours that consist of blood vessels and connective tissue
o Small red papules that don’t regress
• Collagenomas
o Proliferation of normal collagen fibres
o Benign, multiple skin-coloured or hypopigmented nodules on the face, neck, trunk and upper limbs
• Meningiomas
o Benign tumours that arise from the meninges
o In most cases they are asymptomatic
MEN 2A
- Parathyroid adenoma
- Medullary thyroid cancer
- Phaeochromocytoma
• Parathyroid hyperplasia
o Stones, thrones, bones, groans, psych overtones
• Medullary thyroid cancer
• Pheochromocytoma
o high blood pressure, headaches, palpitations, anxiety, sweating, polycythaemia (if they secrete EPO)
MEN 2B
- Thyroid medullary cancer
- Phaeochromocytoma
- Mucosal neuromas
- Marfanoid habitus
• Medullary thyroid cancer
• Pheochromocytoma
o high blood pressure, headaches, palpitations, anxiety, sweating, polycythaemia (if they secrete EPO)
- Multiple mucosal neuromas - Ganglioneuromatosis – occurs in the mouth but can also happen in the intestine (bumps on lips, cheeks, tongue, eyelids)
- Marfanoid habitus – long limbs, long fingers, high arched palate
Carcinoid syndrome symptoms + signs
- Flushing
- Diarrhoea (serotonin increases motility + peristalsis)
- Crampy abdominal pain
- SOB
- Wheeze
- Itching
- Sweating
- Telangiectasias
- Palpitations
- R sided heart murmur – TR, TS, PS [tricuspid + pulmonary associated with carcinoid syndrome]
- Nodular hepatomegaly in cases of metastatic disease
- Decrease in tryptophan needed to make niacin (vitamin B3) - pellagra (inflamed skin, mental confusion)
- Carcinoid crisis – profound flushing, bronchospasm, tachycardia, fluctuating BP
- Symptoms can by worsened by alcohol or emotional stress since these can further stimulate the neuroendocrine cells
Primary hyperaldosteronism/ Conn’s syndrome symptoms + signs
Tend to be asymptomatic
May have symptoms assosciated with hypokalaemia
(salt + water retention due to increased aldostrone causes hypertension + hypokalaemia)
• Hypokalaemia - muscle weakness, muscle cramps, paraesthesias, palpitations, conduction abnormalitie
• HTN RESISTANT to therapy
Complication of HTN e.g. retinopathy, headache etc
- HTN, low plasma renin, increased aldosterone
- Metabolic alkalosis
- Nocturia, polyuria (decreased ability of kidneys to concentrate urine)
- Lethargy, difficulty concentrating, mood disturbance (irritability, anxiety, depression)
Cushing’s syndrome symptoms and signs
- Weight gain
- Central obesity
- Suprascapular fat pad
- Facial rounding
- Plethora
- Proximal myopathy
- Thinning of the skin
- Easy bruising
- Poor wound healing
- Striae
- Susceptibility to infection
- Metabolic complications – DM, dyslipidaemia, osteoporosis, HTN, impaired glucose tolerance
- Eventually insulin resistance develops
- HTN due to pseudohyperaldosteronism (high levels of cortisol can act as a mineralocorticoid (aldosterone))
- High levels of cortisol inhibit secretion of gonadotropin –> Hirsuitism, Acne, Menstrual irregularities
Phaeochromocytoma symptoms + signs
Palpitations
Headaches
HTN
Episodic sweating
Tachycardia
Chest pain
Postural hypotension
Epigastric pain
Nausea
Constipation
Impaired glucose tolerance/DM
Tremor Pallor Anxiety Fever Weight loss
Adrenal insufficiency
Symptoms are vague and non-specific o Fatigue + weakness o Anorexia o Myalgia o Weight loss o Cravings for salt + salty foods o Nausea/Vomiting/Diarrhoea/Constipation o Abdo pain o Muscle cramps + joint pains o Syncope or dizziness o Confusion o Irritability
Signs
o Postural hypotension
o Increased pigmentation
o Loss of body hair in women (androgen deficiency(
o Associated autoimmune condition (e.g. vitiligo)
What is an Addisonian crisis, what are the symptoms and what is it precipitated by?
• Acute loss of renal function – may present as a crisis ppt by infection, surgery, trauma
o Hypotension o Hypovolaemic shock o Tachycardia o Vomiting o Acute abdominal pain o Low-grade fever o Collapse o Shock
Pale cold clammy
all of the above are caused by mineralocorticoid (aldosterone) and glucocorticoid (glucose) deficiency as well as hyponatraemia and hyperkalaemia
Congenital adrenal hyperplasia
21-hydroxylase deficiency
11-beta hydroxylase deficiency
17-hydroxylase deficiency
21-hydroxylase deficiency low cortisol low aldosterone high testosterone A bit hypotensive Monitor w 17α-hydroprogesterone
11-beta hydroxylase deficiency
high 11-deoxycorticosterone (androgen receptor agonist)
17-hydroxylase deficiency
high 11-deoxycorticosterone (androgen receptor agonist)
high aldosterone
Missing cortisol/glucocorticoids + sex steroids
PCOS symptoms and signs
- Oligomenorrhoea/ amenorrhoea
- Infertility
- Hirsutism
- Male pattern hair loss – tinning of hair starting from the crown of the head
- Acne
- Overweight/obesity
- Dyslipidaemia
- Hypertension
- Acanthosis nigricans (dark velvety patches in the creases of the neck, groin, underarms) - sign of severe insulin resistance
Triad of signs assosciated with hyperaldosteronism
Hypertension
Hypokalaemia
Metabolic alkalosis
Pseudohypoparathyroidism signs and symptoms
Pseudohypoparathyroidism – AD, end-organ resistance to PTH
Mental retardation
Short stature
Short 4th + 5th metacarpals
High PTH, low calcitriol, low Ca, high PO43-
Hyperthyroidism cardiac symptoms + signs
Palpitations AF SOB (LVF) Aggravated angina Pulmonary mid-diastolic high flow murmur Cardiomegaly
Triad of signs consistent with hyperaldosteronism
Hypertension
Hyperkalaemia
Metabolic alkalosis
Diabetic retinopathy three stages
Background retinopathy
Hard exudates
Microaneurysms
Blot haemorrhages
Pre-proliferative retinopathy
Cotton wool spots
Proliferative retinopaty
Growth of vessels
If these vessels form near the macula, they can affect acuity + colour vision
Fragile + prone to bleeding
Pituitary apoplexy symptoms + signs
Sudden onset headache
Vomiting
Visual disturbance [most common in the superior qudrant bitemporally]
Hormonal dysfunction
CT - hyperdense area within the pituitary gland
Abrupt growth of pituitary carcinoma causes pituitary infarction
