Endocrine Flashcards
Type 1 Diabetes:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
TreatmentD
Definition - metabolic disorder characterised by hyperglycaemia die to absolute insulin deficiency
Epidemiology - 5-10% of all diabetes patients, <20
Pathogenesis - destruction of pancreatic beta cells mostly via immune mediated mechanisms
Presentation - polyuria, polydipsia, weight loss, blurred vision, nausea, vomiting, abdominal pain, tachypnoea, lathargy, coma
Investigations - eye and foot examination, urinalysis, random plasma glucose, HbA1c, fasting plasma glucose
Differentials - monogenic diabetes, neonatal diabetes, type 2 diabetes
Risk Factors - geographical, genetics
Treatment - basal bolus insulin subcutaneously or fixed dose insulin twice daily
Type 2 Diabetes:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - progressive disorder defined by deficits in insulin secretion and action that lead to abnormal glucose metabolism related to metabolic derangements
Epidemiology - 2.8%, higher in african + asian descent
Pathogenesis - insulin resistance or insensitivity
Presentation - fatigue, polyuria, polydipsia, weight loss, infection, slow healing ulcers, glucose in urine
Investigations - urinalysis, HbA1c, fasting and random plasma glucose, 2 hour post load glucose
Differentials - pre-diabetes, type 1 diabetes, LADA, monogenic diabetes, gestational diabetes
Risk Factors - age, obesity, Fx, hypertension, cardiovascular disease
Treatment - cardiovascular risk reduction,1st line: metformin and lifestyle changes management
2nd line: insulin
Primary Hypothyroidism:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - clinical state resulting from underproduction of T3+T4
Epidemiology - more common in developing world due to iodine deficiency, more common in women
Pathogenesis - hashimotos - lymphocytic infiltration and destruction of thyroid tissue with secondary antibodies to thyroid peroxidase and thyroglobulin and other thyroid antigens, T4 converted to T3 in target tissue
Presentation - weakness, lethargy, clod sensitivity, constipation, weight gain, depression, myalgia, menstrual irregularity, coarse hair, goitre
Investigations - Serum TSH
Differentials - central or secondary hypothyroidism, depression, Alzheimers, anaemia
Risk Factors - female, amiodarone use, primary pulmonary hypertension
Treatment - levothyroxine 1.6 micrograms/kg/day, adjust dose to normalise TSH
Secondary (Central) Hypothyroidism:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - results of anterior pituitary or thalamic hypo function
Epidemiology - 1% hypothyroid cases
Pathogenesis - decreased TSH, potential of pituitary tumour
Presentation - weakness, fatigue, cold intolerance, bradycardia, weight gain, reduced body hair
Investigations - Serum free T4, TSH, prolactin, serum cortisol, MRI, CT head
Differentials - primary hypothyroidism, non-thyroid illness, iodine deficiency, chronic fatigue syndrome
Risk Factors - multiple endocrine neoplasia (MEN) type 2, neck and head irradiation, traumatic brain injury
Treatment - levothyroxine - if adrenal hormone deficiency add corticosteroids
Hyperthyroidism:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - excess thyroid hormone
Epidemiology
Pathogenesis - graves = most common IgG bind to TSH receptors and stimulate thyroid
TSH secreting pituitary adenoma, thyroiditis, exogenous intake of thyroid hormones
Presentation - diarrhoea, weight loss, increased appetite, sweats, heat intolerance, palpitations, tremor, irritability, potentially diffuse goitre without nodules
Investigations - TFTs, autoantibodies, CRP, ESR, thyroid ultrasound
Differentials - pleural thickening, pulmonary collapse, consolidation, elevated hemidiaphragm, pleural tumours
Risk Factors - female, tobacco use
Treatment - thyroid storm: high dose antithyroid drugs, corticosteroids, beta-blockers and iodine solution
Radioactive iodine, cabimazole, hydrocortisone
If pregnant: propylthiouracil
Goitre + Thyroid Nodule:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition -
Goitre = enlargement of thyroid gland, may have nodules
Nodule = limo in otherwise normal thyroid
Epidemiology - mainly adults
Pathogenesis - physiological, autoimmune, acute viral thyroiditis, iodine deficiency, tumour, thyroid cancer: papillary, follicular, medullary or anaplastic
Presentation - often asymptomatic, may cause pain
Investigations - Thyroid examination, TFTs, ultrasound thyroid, fine needle aspiration, red flags: stridor, unexplained hoarseness, voice change
Differentials - non toxic simple goitre, toxic multi nodular goitre, retrosternal goitre, colloid nodule, thyroid cysts
Risk Factors - more common in areas of low iodine consumption, malignancy more common where benign thyroid disease existed
Treatment - euthyroidism if necessary, surgery for cosmetics or malignancy
Cushing’s:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - hypercortisolism from any cause
Epidemiology - F4:M1
Pathogenesis - ATH secreting pituitary tumours by autonomous adrenal cortisol over production, ACTH secreting tumours
Presentation - focal plethora, hypertension, pathological fractures, moon face
Investigations - Urine pregnancy test, salivary cortisol, serum glucose, 24hr urine free cortisol, 48hr 2mg dexamethasone suppression test
Differentials - obesity, metabolic syndrome
Risk Factors - exogenous corticosteroid use, pituitary adenoma, adrenal adenoma, adrenal carcinoma
Treatment - 1st line: transphenoidel pituitary adenectomy
2nd line: repeat 1st line
3rd line: pituitary radiotherapy
4th line: bilateral adrenalectomy
Parathyroid adenoma:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - benign tumour on parathyroid glands
Epidemiology - 1% incidence rate, post menopausal women
Pathogenesis - over expression of cyclin D1 gene and MEN syndrome
Presentation - bone fractures, urinary calculi, mental changes, nausea, vomiting, pain in muscles and abdomen, polyuria, polydipsia, nocturia
Investigations - glucose to rule out hyperglycaemic crisis, serum calcium, PTH, ultrasound, sestamibi radioisotope
Differentials - monogenic diabetes, neonatal diabetes, latent autoimmune diabetes, type 2 diabetes
Risk Factors - MEN gene, cyclin D1 gene
Treatment - 1st line: parathyroidectomy if tumour is known, if unknown then bilateral neck exploration and removal of enlarged area
Primary Hyperparathyroidism:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - endocrine disorder of PTH resulted in derangement of calcium metabolism
Epidemiology - 1 in 500 women, 1 in 2000 men, more common in post menopausal women
Pathogenesis - PTH is not suppressed as expected with high calcium levels
Presentation - Bones Stones Moans and Groans nephrotheliasis, bone pain, fatigue, anxiety, calcium stones, abdominal pain
Investigations - serum calcium, PTH, assay
Differentials - hypocalciuric hypercalcaemia, humoural hypercalcaemia of malignancy, multiple myeloma, sarcoidosis
Risk Factors - female, over 50, MEN 1, 2A or 4, current or history of lithium treatment
Treatment - parathyroidectomy
Secondary Hyperparathyroidism:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - abnormalities of calcium, phosphorus, PTH or Vitamin D metabolism, abnormalities in bone tumour
Epidemiology - CKD association or via D deficiency, caucasians
Pathogenesis - any disorder resulting in hypocalcaemia with elevated PTH levels, CKD malabsorption syndromes, chronic inadequate exposure to sunlight
Presentation - discolour skin, bruising, pruritus, fluid overload, elevated BP, fatigue, nausea
Investigations - Chvostek’s sign: tapping on face, twitch of muscle around mouth
Trousseaus sign: blood pressure cuff above diastolic for 3 mins cause muscle flexion wrist, serum calcium, PTH, creatinine, urea nitrogen
Differentials - primary hyperparathyroidism
Risk Factors - ageing, chronic renal failure, vitamin D deficiency, nutritional deficiency
Treatment - UV radiation exposure, vitamin D and calcium supplement, optimised management of underlying disease
Addisons Disease:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment
Definition - adrenal insufficiency - reduced cortisol, aldosterone and dehydrpepiandosterone
Epidemiology- 5-10% of all diabetes patients, <20
Pathogenesis - decreased production of adrenocortical hormones
Primary: destruction or dysfunction of adrenal gland
Secondary: inadequate pituitary adrenocorticotropic hormone (ACTH)
Tertiary: inadequate hypovolaemic corticotropin releasing hormone and subsequent ACTH release
Presentation - fatigue, anorexia, weight loss, hyperpigmentation, salt craving
Investigations - serum electrolytes, blood urea, FBC, morning serum cortisol, ACTH stimulation test
Hyponatraemia, hypercalcaemia, hyperkalaemia
Differentials - adrenal suppression due to corticosteroid therapy, haemochromatosis, hyperthyroidism, occult malignancy, anorexia nervosa
Risk Factors - female, TB, non-TB bacterial infection
Treatment - adrenal crisis: glucocorticoid and supportive therapy, hydrocortisone sodium succinate IV
Ongoing: glucocorticoid plus mineralocorticoid - hydrocortisone or prednisolone and fludrocortisone
