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ICM Matrix > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Signs of diabetes mellitus

A

Polyuria
Polydipsia
weight loss

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2
Q

What are the types of diabetes?

A

T1DM = an absolute insulin deficiency causes persistent hyperglycaemia. (autoimmune)

T2DM = a combination of insulin resistance/insensitivity and insulin deficiency

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3
Q

Diagnostic criteria for diabetes

A

Symptomatic:
1. fasting glucose > 7.0 mmol/l

  1. random glucose > 11.1 mmol/l (or after 75g oral glucose tolerance test)

HbA1c > 48 mmol/mol

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4
Q

4 main ways to check blood glucose

A
  1. a finger-prick bedside glucose monitor
  2. a one-off blood glucose.
  3. a HbA1c.
  4. a glucose tolerance test.
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5
Q

Signs and symptoms of DKA

A

Common in new diagnosis T1DM:

  1. abdominal pain
  2. polyuria, polydipsia, dehydration
  3. deep hyperventilation ( kussmaul breathing)
  4. acetone-smelling breath (‘pear drops’ smell)
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6
Q

When should HbA1c be monitoried for T1DM?

A

Every 3-6 months

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7
Q

What is the HbA1C targets for T2DM?

A

Lifestyle = 48
Lifestyle + metformin = 48
Lifestyle + any drug cause hypoglycaemia (sulfonylurea) = 53

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8
Q

Diabetes Mellitus sick day rules

A
  1. Increase frequency of blood glucose monitoring to four hourly or more frequently
  2. Encourage fluid intake aiming for at least 3 litres in 24hrs
  3. If unable to take struggling to eat may need sugary drinks to maintain carbohydrate intake
  4. It is useful to educate patients so that they have a box of ‘sick day supplies’ that they can access if they become unwell
  5. Access to a mobile phone has been shown to reduce progression of ketosis to diabetic ketoacidosis
  6. Continue taking medication
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9
Q

What is Hashimoto’s thyroiditis

A

autoimmune disorder of the thyroid gland

typically associated with hypothyroidism although there may be a transient thyrotoxicosis in the acute phase

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10
Q

Clinical features of Hashimoto’s thyroiditis

A
  • hypo sx
  • goitre
  • anti-TPO and anti-thyroglobulin antibodies
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11
Q

What may trigger thyroid storm

A
  • surgery
  • trauma
  • infection
  • iodine load e.g CT Contrast
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12
Q

What is Subacute (De Quervain’s) thyroiditis

A

thought to occur following viral infection and typically presents with hyperthyroidism

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13
Q

Investigations for Subacute (De Quervain’s) thyroiditis

A

thyroid scintigraphy: globally reduced uptake of iodine-131

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14
Q

Diagnostic critieria for DKA

A
  1. glucose > 11 mmol/l or known diabetes mellitus
  2. pH < 7.3
  3. bicarbonate < 15 mmol/l
  4. ketones > 3 mmol/l or
  5. urine ketones ++ on dipstick
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15
Q

What is hypoglycaemia

A

blood glucose concentrations <3.5 mmol/L

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16
Q

Symptoms of hypoglycaemia

A
  • Sweating
  • Shaking
  • Hunger
  • Anxiety
  • Nausea
  • weakness
  • vision change
  • confusion
  • dizziness
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17
Q

Symptoms of severe hypoglycaemia

A
  • convulsion

- coma

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18
Q

Define hypercholesterolaemia

A

Total cholesterol > 7.5 mmol

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19
Q

What is Addison’s disease?

A

Reduced cortisol + aldosterone produced

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20
Q

Features of Addison’s disease

A
  1. lethargy, weakness, anorexia, nausea & vomiting, weight loss, ‘salt-craving’
  2. hyperpigmentation (especially palmar creases)*, vitiligo, loss of pubic hair in women, hypotension,
  3. hypoglycaemia
    hyponatraemia and hyperkalaemia may be seen
  4. crisis: collapse, shock, pyrexia
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21
Q

Definitive investigation for Addison’s disease

A

ACTH Test (Short synacthen test)

Other:
9 am Serum Cortisol
1. > 500 nmol/l = Addison’s very unlikely
2. < 100 nmol/l = abnormal
3. 100-500 nmol/l = ACTH stimulation indicated

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22
Q

What is Addison’s crisis?

A

Acute exacerbation of chronic insufficiency

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23
Q

Causes of Addisonian crisis

A
  1. Sepsis or surgery
  2. adrenal haemorrhage
  3. steroid withdrawal
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24
Q

Clinical features of hypothyroidism

A
  • Weight gain
  • Lethargy
  • Cold intolerance
  • dry skin, brittle hair
  • constipation
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25
Q

What is the most common cause of hypothyroidism

A

Hashimoto’s thyroiditis

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26
Q

What are the expected TFT results in primary hypothyroidism

A

High TSH, Low T4

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27
Q

What are the expected TFT results in Secondary hypothyroidism

A

Low TSH, Low T4

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28
Q

How is hypothyroidism classified

A

Primary = problem with thyroid gland itself

Secondary = disorder with pituitary gland

Congenital

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29
Q

How long after levothyroxine dose change should TFT be repeated?

A

8-12 weeks

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30
Q

What is the most common cause of thyrotoxicosis

A

Graves’ disease

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31
Q

Epidemiology of Graves Disease

A

women 30-50 yo

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32
Q

Clinical signs of Graves disease

A
  • exophthalmos

- pretibial myxoedema

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33
Q

Which antibodies can help distinguish Graves disease from other forms of hyperthryoidism?

A

TSH Receptor stimulating antibodies

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34
Q

What is Graves Disease

A

autoimmune condition leading to overactive thyroid glands

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35
Q

What is the typical description of a patient with hyperparathyroidism in exam questions?

A

elderly females with an unquenchable thirst and an inappropriately normal or raised parathyroid hormone level

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36
Q

How do most patients with hyperparathyroidism present?

A

80% are asymptomatic

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37
Q

Mnemonic used to remember symptomatic features of primary hyperparathyroidism

A

bones, stones, abdominal groans and psychic moans

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38
Q

What are the expected blood results in primary hyperparathyroidism?

A

normal or raised PTH

raised Ca , low Phosphate

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39
Q

Characteristic Xray finding of hyperparathyroidism

A

pepperpot skull

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40
Q

What is hyperparathyroidism

A

condition in which one or more of the parathyroid glands makes too much PTH leading to excess calcium production

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41
Q

Most common cause of hyperparathyroidism

A

solitary adenoma

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42
Q

What are the expected blood results in secondary hyperparathyroidism?

A

High PTH

Low/normal Ca, High Phosphate

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43
Q

Cause of secondary hyperparathyroidism

A

CKD = low calcium = PTH Hyperplasia

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44
Q

What is hypoparathyroidism?

A

inadequate PTH activity = low calcium, high phosphate

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45
Q

What is Tertiary hyperparathyroidism?

A

High PTH = normal or high Ca = normal of low Phosphate

HIGH ALP

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46
Q

What is the cause of Tertiary hyperparathyroidism?

A

ongoing hyperplasia of the parathyroid glands after correction of underlying renal disorder

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47
Q

Treatment for Tertiary hyperparathyroidism?

A

Allow 12 months to elapse following transplant as many cases will resolve

otherwise parathyroidectomy or excision of affected gland

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48
Q

Main sx of hypoparathyroidism

A

secondary to hypocalcaemia

  • Tetany: muscle twitching, cramping, spasm
  • perioral paraesthesia
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49
Q

Tx hypoparathyroidism

A

alfacalcidol

50
Q

Symptoms of thyroid cancer

A
  • a painless lump in neck
  • lymphadenopathy
  • unexplained hoarseness that does not get better after a few weeks.
  • persistent sore throat
  • difficulty swallowing
51
Q

What is Cushing’s?

A

Glucocorticoid excess –> increased cortisol

52
Q

What tests confirm Cushing’s?

A

1st line = overnight dexamethasone suppression test
In Cushing’s syndrome - you do not have their morning cortisol spike suppressed

24 hr urinary free cortisol

53
Q

Symptoms of Cushing’s syndrome

A
  1. Moon Face”, “buffalo hump”, truncal obesity
  2. Weight gain
  3. Gonadal dysfunction (Oligomenorrhea and infertility, decreased libido, hirsutism, erectile dysfunction)
  4. Mood change - emotional lability, anxiety, depression
  5. Proximal muscle weakness
  6. Thirst and polyuria (due to hyperglycaemia)
54
Q

Interpretation of high-dose dexamethasone test

A
  1. Normal Cortisol + Supressed ACTH = Adrenal cause
  2. Low Cortisol + Low ACTH = Cushing’s disease
  3. Normal Cortisol + high ACTH = Ectopic ACTH
55
Q

What is Gynaecomastia?

A

Abnormal amount of breast tissue in males

-> caused by an increased oestrogen: androgen ratio.

56
Q

Causes of hyponatraemia

A

Sodium depletion

  • diuretics
  • Addisons disease
  • renal failure
  • diarrhoea
  • vomiting
  • burns

Water excess

  • secondary hyperaldosteronism
  • nephrotic syndrome
57
Q

Complication of severe hyponatraemia if left untreated

A

cerebral oedema

58
Q

What is used to treat acute hyponatraemia with severe symptoms?

A

Hypertonic saline (NaCl)

59
Q

Euvolaemic causes of hyponatraemia

A
  • SIADH (impaired water excretion caused by the inability to suppress ADH secretion)
  • Hypothyroidism (decreased rate of free water excretion)
60
Q

Tx of chronic hyponatraemia if hypovolaemic cause

A

Hypertonic saline (NaCl)

61
Q

Tx of chronic hyponatraemia if euvolaemic cause

A

fluid restrict (500-1000ml/day)

  • consider demeclocycline
  • consider Vasopressin receptor antagonists (Vaptans))
62
Q

Tx of chronic hyponatraemia if hypervolaemic cause

A

fluid restrict to 500–1000 mL/day

  • consider loop diuretics
  • consider Vasopressin receptor antagonists (Vaptans)
63
Q

When should Vaptans be avoided

A

hypovolaemic hyponatraemia

- may precipitate hypotension and renal failure

64
Q

Causes of hypernatraemia

A

dehydration
osmotic diuresis e.g.
diabetes insipidus
excess IV saline

65
Q

Complication of rapidly correcting hypernatraemia

A

cerebral oedema = coma, seizure, death

66
Q

Treatment of hypovolaemic hypernatraemia

A

IV Saline

67
Q

Treatment of hypervolaemic hypernatraemia

A

diuretics and 5% dextrose

68
Q

Investigations in hypo/hypernatraemia

A
  • serum osmolality

- serum electrolytes, urea, creatinine, and glucose

69
Q

Causes of hypomagnasaemia

A 
drugs
diuretics
PPIs
total parenteral nutrition
diarrhoea
alcohol
hypokalaemia
hypercalcaemia
metabolic disorders
70
Q

Signs and sx of hypomagnasaemia

A

similar to hypercalcaemia

  • tetany
  • seizures
  • arrhythmias
71
Q

Tx of hypomagnasaemia

A

IV Magnesium

Oral Mg salts if <0.4

72
Q

Features of hypocalcaemia

A

tetany: muscle twitching, cramping and spasm
perioral paraesthesia
if chronic: depression, cataracts

73
Q

ECG finding in hypocalcaemia

A

prolonged QT interval

74
Q

What is Trousseau’s sign

A

sign of hypocalcaemia where carpal spasm occurs if the brachial artery occluded by inflating the blood pressure cuff and maintaining pressure above systolic

75
Q

Causes of hypocalcaemia

A
  • vitamin D deficiency (osteomalacia)
  • CKD
  • hypoparathyroidism
  • Acute pancreatitis
76
Q

What might cause falsely low Ca levels

A

contamination of blood samples with EDTA

77
Q

ECG finding in hypercalcaemia

A

shortened QT interval

78
Q

Sx of hypercalcaemia

A

‘bones, stones, groans and psychic moans’

79
Q

2 main causes of hypercalcaemia

A

Primary hyperparathyroidism

Malignancy

80
Q

Initial tx of hypercalcaemia

A

rehydration with normal saline

81
Q

Which drugs may be used to treat hypercalcaemia

A
  • bisphosphonates
  • calcitonin
  • Loop diuretics (CAUTION as may worsen electrolyte derangement)
82
Q

What is Galactorrhoea?

A

Milky secretion from the breasts , not due to breastfeeding.

83
Q

Cause of Galactorrhoea

A

Excess prolactin due to drugs or physiological factors:

  • prolactinoma
  • pregnancy
  • acromegaly
  • primary hypothyroidism
  • PCOS
84
Q

Features of excess prolactin

A
  1. men: impotence, loss of libido, galactorrhoea

2. women: amenorrhoea, galactorrhoea

85
Q

Investigations for Galactorrhoea

A
  • Prolactin, TFTs, U&Es, LFTs

+/- hCG

  • MRI (prolactinoma)
86
Q

What is lactose intolerance?

A

An enzyme deficiency, rather than lactose allergy, which is an IgE-mediated reaction

87
Q

Symptoms of lactose intolerance

A

Gas build-up:

  • Bloating
  • flatulence
  • Abdominal discomfort

Acidic and osmotic effects of undigested lactose:

  • Loose watery stool
  • Perianal itching due to acidic stools
88
Q

Diagnosis of lactose intolerance

A

Can be made on clinical features alone

Trial of 2-week period of strict lactose -free diet

No single diagnostic test:

  • A lactose tolerance test
  • Breath hydrogen test
89
Q

What is Phaeochromocytoma?

A

Catecholamine-secreting tumour formed by chromaffin cell within the adrenal medulla
–> Catecholamine = norepinephrine epinephrine

90
Q

Symptoms of Phaeochromocytoma

A

Triad:

  1. headaches
  2. palpitations and tachycardia
  3. sweating

Other:

  • hypertension
  • anxiety
91
Q

Investigations for Phaeochromocytoma

A

24 hr urinary collection of metanephrines (sensitivity 97%*)

92
Q

What is Acromegaly?

A

Excessive secretion of growth hormone due to pituitary adenoma.

Acromegaly causes an overgrowth of all organ systems, bones, joints and soft tissues.

93
Q

Features of Acromegaly

A
  1. coarse facial appearance, spade-like hands, increase in shoe size
  2. large tongue, prognathism, interdental spaces
  3. excessive sweating and oily skin: caused by sweat gland hypertrophy
  4. features of pituitary tumour = hypopituitarism, headaches, bitemporal hemianopia
  5. raised prolactin in 1/3 of cases → galactorrhoea
94
Q

1st line investigation for Acromegaly

A

Serum IGF-1 levels

95
Q

Other investigation for Acromegaly

A

Oral glucose tolerance test:
1. in normal patients GH is suppressed to < 2 mu/L with hyperglycaemia

  1. in acromegaly there is no suppression of GH
  2. may also demonstrate impaired glucose tolerance which is associated with acromegaly

Pituitary MRI = pituitary tumour.

96
Q

1st line treatment for Acromegaly

A

Trans-sphenoidal surgery

97
Q

What is Diabetes insipidus?

A

Either:
1. a decreased secretion of antidiuretic hormone (ADH) from the pituitary (cranial DI)

or

  1. an insensitivity to antidiuretic hormone (nephrogenic DI)
98
Q

Symptoms of Diabetes insipidus

A
  1. Polyuria (dilute urine)
  2. polydipsia (thirst)
  3. dehydration
99
Q

Investigation for Diabetes insipidus

A
  1. U&Es (hypernatremia, hyperuricemia)
  2. Plasma & urine osmolality
    - -> high plasma osmolality, low urine osmolality
    - -> a urine osmolality of >700 mOsm/kg excludes diabetes insipidus
  3. Water deprivation test - urine abnormally dilute
100
Q

What is Conn’s syndrome?

A

Primary hyperaldosteronism

101
Q

Features of Conn’s syndrome

A
  1. hypertension
  2. hypokalaemia
    - -> muscle weakness
102
Q

1st line investigation in suspected Conn’s syndrome

A

Plasma aldosterone/renin ratio

- High aldosterone + low renin

103
Q

Next step after 1st line investigation in Conn’s syndrome

A

High-resolution CT abdomen + adrenal vein sampling

104
Q

Most common cause of Addison’s

A

Autoimmune

105
Q

Causes of hyperkalaemia

A
  • AKI
  • Addisons disease
  • Rhabdomyolysis
  • Drugs
106
Q

Which drugs cause hyperkalaemia

A

ACEi, ARB, spironolactone, heparin

107
Q

ECG changes seen in hyperkalaemia

A

tall-tented T waves, small P waves, widened QRS

108
Q

What does untreated hyperkalaemia lead to?

A

life-threatening arrhythmias

109
Q

Emergency treatment of severe hyperkalaemia

A
  • IV calcium gluconate: to stabilise the myocardium

- insulin/dextrose infusion: short-term shift in potassium from ECF to ICF

110
Q

Sx of hyperkalaemia

A
  • muscle weakness
  • numbness
  • palpitations
  • sob
  • n&v
111
Q

Sx of hypokalaemia

A
  • muscle weakness

- hypotonia

112
Q

What does hypokalaemia predispose patients to?

A

digoxin toxicity

113
Q

ECG features of hypokalaemia

A

U waves, long PR, long QT

114
Q

Causes of hypokalaemia

A
  • diuretics
  • diarrhoea
  • vomiting
  • excess alcohol
  • DKA
  • CKD
115
Q

What is metabolic alkalosis

A

loss of hydrogen ions or gain of bicarbonate

116
Q

Main causes of metabolic alkalosis

A
  • vomiting
  • diuretics
  • hypokalaemia
  • primary hyperaldosteronism
  • Cushing’s syndrome
117
Q

What is the normal anion gap

A

10-18mmol/L

118
Q

Causes of metabolic acidosis

A

normal anion gap

  • GI (diarrhoea)
  • Addisons

raised anion gap

  • lactate (shock, sepsis, hypoxia)
  • ketone (DKA, alcohol)
  • renal failure
119
Q

Common causes of resp alkalosis

A
  • anxiety = hyperventilation
  • PE
  • pregnancy
  • altitude
  • salicylate poisoning
  • stroke
  • subarrachnoid haemorrhgae
120
Q

Common causes of resp acidosis

A
  • COPD
  • Decompensation in other resp conditions
  • sedative drug OD
  • neuromuscular disease

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