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Endocrine Flashcards

1
Q

Thyrotoxicosis

A
  • Preference for cooler weather
  • Weight loss
  • Polyphagia
  • Palipitations
  • Increased sweating
  • Nervousness
  • Irritability
  • Diarrhoea
  • Amenorrhea
  • Muscle weakness
  • Exertional dyspnoea
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2
Q

Hypothyroidism

A
  • Preference for warmer weather
  • Lethargy
  • Oedema of eyelids
  • Hoarse voice
  • Constipation
  • Coarse skin
  • Hypercarotinaemia
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3
Q

Diabetes Mellitus

A
  • Polyuria
  • Polydipsia
  • Thirst
  • Blurred vision
  • Weakness
  • Infections
  • Groin itch, rashes
  • Weight loss
  • Tiredness
  • Lethargy
  • Disturbance of conscious state
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4
Q

Hypoglycaemia

A
  • Morning headeaches
  • Weight gain
  • Seizures
  • Sweating
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5
Q

Primary Adrenal Insufficiency

A
  • Pigmentation
  • Tiredness
  • Loss of weight
  • Anorexia
  • Nausea
  • Diarrhoea
  • Nocturia
  • Mental changes
  • Seizures (hypotension and hypoglycaemia)
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6
Q

Acromegaly

A
  • fatigue
  • weakness
  • increased sweating
  • heat intolerance
  • weight gain
  • enlarging hands and feet
  • enlarged and coarsened facial features
  • headaches
  • decreased vision
  • voice change
  • decreased libido
  • impotence
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7
Q

Cushing’s syndrome

A
  • truncal obesity
  • purple striae
  • moon-like facies
  • buffalo hump
  • myopathy
  • bruises
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8
Q

Causes of Midline Neck Swellings

A
  • Goitre (moves up on swallowing)
  • Thyroglossal cyst (moves on stickign out tongue)
  • Submental LN’s.
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9
Q

Causes of Lateral Neck Swellings

A
  • LN’s.
  • Submandibular gland
  • Parotid gland
  • Skin
    • Sebaceous cyst
    • Lipoma
  • Lymphatics
    • cystic hygroma
  • Carotid artery
    • aneurysm
    • tumour
  • Pharynx
    • pharyngeal pouch
    • branchial cyst
  • Parathyroid gland (very rare)
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10
Q

Differential of a thyroid nodule

A
  • Carcinoma (5%) - fixed, palpable LN’s, vocal cord paralysis, hard.
  • Adenoma - mobile, no local associated features
  • Big nodule in a multinodular goitre
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11
Q

Causes of a diffuse goitre

A
  • idiopathic
  • puberty or pregnancy
  • thyroiditis
    • hashimoto’s
    • subacute(tender)
  • simple goitre of iodine deficiency
  • goitrogens - iodine, lithium, other drugs
  • inborn errors of thyroid hormone synthesis
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12
Q

Causes of a solitary thyroid nodule

A
  • Benign
    • dominant nodule in multinodular goitre
    • degeneration or haemorrhage into a colloid cyst or nodule
    • follicular adenoma
    • simple cyst (rare)
  • Malignant
    • carcinoma
    • Lymphoma (rare)
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13
Q

Causes of exopthalmos

A
  • Bilateral
    • graves disease
  • Unilateral
    • Tumours of the orbit
    • cavernous sinus thrombosis
    • grave’s disease
    • pseudotumours of the orbit
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14
Q

Causes of thyrotoxicosis

A
  • Primary
    • graves disease
    • toxic multinodular goitre
    • toxic adenoma
    • Hashimoto’s thyroiditis early in its course
    • subacute thyroiditis (transient)
    • Post-partum thyroiditis (non-tender)
    • Iodine -induced (after previously deficient diet)
  • Secondary
    • TSH hypersecretion from pituitary
    • HCG secretion from hydatiform mole or choricarcinoma(rare)
    • Struma ovarii (rare)
    • Drugs - excess TH ingestion, amiodarone
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15
Q

Causes of hypothyroidism

A
  • Primary
    • Without a goitre
      • idiopathic atrophy
      • treatment of thyrotoxicosis
      • agenesis or lingual thyroid
      • unresponsiveness to TSH
    • With a goitre
      • chronic autoimmune disease (Hashimoto’s)
      • Drugs - lithium or amiodarone
      • Inborn errors
      • Iodine defiency
  • Secondary: Pituatary lesions
  • Tertiary:Hypothalamic lesions
  • Transient
    • thyroid hormone treatment withdrawn
    • subacute thyroiditis
    • postpartum thyroiditis
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16
Q

Neuro of Hypothyroidism

A
  • Common
    • Entrapment :carpal tunnel
    • Delayed ankle jerks
    • Muscle cramps
  • Uncommon
    • peripheral nueropathy
    • proximal myopathy
    • psychosis
    • coma
17
Q

Causes of hypopituitarism

A
  • Space occupying lesions
  • iatrogenic (surgery or irradiation)
  • Head injury
  • Sheehan’s syndrome
  • Empty sella syndrome
  • Infarction or pitiutary apoplexy
  • idiopathic
18
Q

Male Tanner Staging

A
  1. Preadolescent
  2. enlargement of testes and scrotum
  3. lengthening of penis
  4. increase penis breadth, glans development and scrotal darkening
  5. adult - all of the above and pubic hair spreading to medical surface of the thighs
19
Q

Female Tanner Staging

A
  • Breasts
    1. preadolescent
    2. breast bud - elecation of breasts and papilla
    3. enlargement of breast and areola - no separation of contours
    4. areola and papilla project above breast level -secondary mound
    5. adult - areola is recessed and papilla projects
  • Pubic hair
    1. no pubic hair
    2. sparse growth, mainly over labia
    3. darker, coarser, more curled hairs but sparse over the junction of the pubes
    4. adult type hair but no spread to the medial thighs
    5. adult horizontal pattern and hair spread to medial thighs
20
Q

Causes of Cushing’s syndrome

A
  • exogenous administration of excess steroids or ACTH
  • Adrenal hyperplasia
    • secondary to pituitary ACTH production(Cushings disease)
    • microadenoma
    • macroadenoma
    • pituitary-hypothalamic dysfunction
    • secondary tto ACTH producing tumours
  • Adrenal neoplasia, adenoma or carcinoma
21
Q

Causes of Addison’s Disease

A
  • Chronic
    • Primary
      • Autoimmune adrenal disease
      • Infection (TB, HIV)
      • Granuloma
      • Follwing heparin therapy
      • Malignant infiltration
      • Haemochromatosis
      • Adrenoleucodystrophy
    • Secondary
      • Pituitary or hypothalamic disease
  • Acute
    • Meningococcal septicaemia
    • adrenalectomy
    • any stress in a patient with chronic hypoadrenalism or abrupt cessation of prolonged high dose steroid therapy
22
Q

Combinations in automimmune polyglandular syndromes

A
  • Type 1 (rare autosomal recessive)
    1. Chronic mucocutaneous candidiasis
    2. Hypoparathyroidism
    3. Addison’s disease
  • Type 2 (more common)
    1. Type 1 DM
    2. Autoimmuine thyroid disease
    3. Addison’s disease
    4. Myasthenia gravis
    5. Pernicious anaemia
    6. Primary gonadal failure
23
Q

Causes of hypercalcaemia

A
  • primary hyperparathyroidism
  • carcinoma
  • thiazide diuretics
  • vitamin d excess
  • thyrotoxicosis
  • associated with renal failure
  • multiple myeloma
  • familial hypocalciuric hypercalcaemia
  • prolonged immobilisation or space flight
24
Q

Causes of hypocalcaemia

A
  • hypoparathyroidism
  • malabsorption
  • vitamin d deficiency
  • chronic renal failure
  • acute pancreatitis
  • pseudohyperparathyroidism
  • magnesium deficiency
  • hypocalcaemia of malignant disease
25
Q

Causes of hirsutism

A
  • PCOS
  • idiopathic
  • androgen secreting tumours
  • drugs - phenytoin, diazoxide, streptomycin, anabolic steroids
  • acromegaly
  • porphyria cutanea tarda
26
Q

Causes of pathological gynaecomastia

A
  • Increased oestrogen production
    • leydig cell tumour
    • adrenal carcinoma
    • bronchial carcinoma (HCG)
    • liver disease
    • thyrotoxicosis
    • starvation
  • decreased androgen production
    • klinfelter’s syndrome
    • secondary testicular failure
  • testicular feminisation syndrome
  • Drugs
    • oestrogen receptor binders - oestrogen, digoxin, marijuana
    • anti-androgens - spirinolactone, cimetedine
27
Q

Diagnostic critera for DM

A
  • fasting plasma venous blood sugar level of 7.0mmol/L or more
  • 2 hour postprandial blood sugar level of 11.1mmol/L or more on more than 1 occasion
28
Q

Causes of DM

A
  1. Type 1
    • Type 1 A - autoimmune destruction of B cells
    • Adult-onset type 1 (islet cell antibodies)
  2. Type 2 - insulin deficieny and resistance
  3. Other types
    • mutations leading to abnormalities of b cell function
    • inherited defects of inuslin action
    • disease of the exocrine [ancreas
    • endocrine abnormalities
    • drug induced - steroids, COC, phenytoin, thiazide diuretics
    • infections like CMV, coxsackie and rubella
  4. Gestational diabetes
29
Q

Cushing’s

A

Signs that suggest adrenal carcinoma

  • palpable abdominal mass
  • virilisation in the female
  • gynaecomastia

Signs that suggest ectopic ACTH production

  • absence of cushingoid body habitus
  • more prominent oedema and hypertension
  • marked muscle weakness

Hyperpigmentation suggests and extrra adrenal tumour or enlargement of an ACTH secreting pituatary adenoma.

30
Q

MEN syndromes

A

MEN Type 1 (chromosone 11)

  • parathyroid tumour
  • pituitary tumour
  • tumour of pancreatic islet cells

MEN Type 2 a(chromosome 10)

  • medullary carcinoma of the thryoid
  • hyperparathyroidism
  • phaeochromocytoma

MEN Type 2 b

  • mucosal neuroma’s
  • medullary thyroid ca
  • phaechromocytoma
31
Q

Complications of proptosis

A
  • chemosis (oedema of the conjunctiva and injection of the sclera)
  • conjunctivitis
  • corneal ulceration
  • optic atrophy
  • opthalmoplegia
32
Q

Anaemia in hypothyroidism

A
  • chronic disease
  • folate deficiency due to bacterial overgrowth
  • Vit B12 deficiency due to associated pernicious anaemia
  • Iron deficiency due to menorrhagia
33
Q

Presentation of Pituitary tumours

A
  • local effects such as headaches, visual field loss and loss of acuity
  • changes in pituitary hormone secretion
    • excess GH -> acromegaly
    • excess ACTH -> cushings
    • excess prolactin -> galactorrhea, secondary amenorrhea, male infertility
    • excess TSH -> hyperthyroidism
34
Q

Order of loss of hormone production in panhypopituitarism

A
  • GH leading to dwarfism in children and insulin sensitivty in adults
  • Prolactin leading to failure of lactation after delivery
  • Gonadotrophins leasing to loss of secondary sexual characteristics, amenorrhea in women, and loss of libido and inferitlity in men
  • TSH leading to hypothyroidism
  • ACTH leading to hypoadernalism(loss of secondary sexual hair due to androgens)

Internal Medicine (9 decks)

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