endocrine Flashcards
general metabolic symptoms
Lethargy
Poor appetite
Vomiting
Jaundice
Underdevelopment (size, weight)
Weight loss
Seizures
Coma
Odour changes to breath, sweat, saliva
Cushings syndrome signs and symptoms
symptoms result from high levels of cortisol
Moon face
buffalo hump
muscle wasting
stretch marks
weight gain
easy bruising
skin and bone thinning
low libido
menstrual changes
hirsutism
Addisons disease signs and symptoms
bronzing of the skin
changes in body hair distribution
gi disturbances
weakness
hypoglycemia
postural hypertension
weight loss
adrenal crisis:
profound fatigue
dehydration
vascular collapse low bp
lower serum Na
increased serum K
Hyperparathyroidism signs and symptoms
70-80% asymptomatic (primary)
Physical examination may be normal
Symptom severity varies with developmental rapidity, and level of hypercalcaemia
stones, bones, abdominal moans, and psychic groans
loss of appetite
nausea
vomiting
constipation
muscle weakness
aches and pains in bones and joints
fatigue depression confusion
renal stones increase thirst increased urination
(Typically)
Tachycardia
tremor
hyperreflexia
anxiety
irritability
emotional liability
panic attacks
Heat intolerance
sweating
increased appetite yet weight loss
Grave’s disease signs and symptoms
Opthalmopathy signs
Blurred vision, photophobia, lacrimation, double vision, deep orbital pressure
Periosteal new bone formation may mimic finger clubbing (as well as in other skeletal areas)
Pretibial myxoedema (immune related deposition of mucopolysaccharides in pretibial skin)
Hypothyroidism signs and symptoms
Usually
Fatigue, lethargy, weakness, constipation, weight gain, cold intolerance, muscle weakness, slow speech, poor memory
Skin is dry, coarse and thick, with non-pitting oedema in the eyelids and hands (myxoedema)
Hair: brittle and coarse, loss of outer 3rd of eyebrows
Facies: dulled expression, slowed speach
Palpable thyroid gland (depends on cause)
Bradycardia
Delayed relaxation phase of reflexes, cerebellar ataxia, hearing impairment, poor memory, dementia, peripheral neuropathy and paresthesia
MSK: carpal tunnel, stiffness, weakness
“Slow in thought, speech and deed”
Paget’s Disease sings and symptoms
Physical presentation
Many lesions are asymptomatic
Skeletal Px (M/C hip and pelvis)
Leg bowing, pathological Fx
Increased heat of extremity
Skull and vertebral enlargement
Neurological impairment, vision, hearing loss, radicular Px and cord compression
Secondary OA due to e.g. abnormal loading
Heart failure (compression, shunting) – rarely seen, only in severe cases
Diabetes Mellitus signs and symptoms
slow wound healing
constant hunger
frequent urination
blurred vision
fungal infection and itchy skin
unexplained weight loss
numbness of the hands and feet
Clinical presentation
May be normal in early stages
Symptoms of hyperglycaemia
Polyuria, thirst, blurred vision
Diabetic retinopathy
Non-proliferative
Proliferative
Cataracts
Glaucoma
Peripheral neuropathy
Mononeuropathies involving CN III, IV and V, as well as intercostal and femoral nerves, are common
Neuropathy – physical exam
Decreased pinprick, light sensation and pain sensations
Decreased vibration sense
Loss of proprioception
Motor disturbances
Decreased reflexes, weakness, atrophy
Unable to pick up objects, turn page in a book – affects ability to self care
Neuropathy – physical exam
Decreased pinprick, light sensation and pain sensations
Decreased vibration sense
Loss of proprioception
Motor disturbances
Decreased reflexes, weakness, atrophy
Unable to pick up objects, turn page in a book – affects ability to self care
Nephropathy
Pedal oedema
Pallor
Weakness
Foot ulcers
Arthropathy (Charcot’s joints)
Bone/joint deformity d/t repeated traumas (2o to neuropathy)
Diabetes Insipidus signs and symptoms
Excessive thirst: People with diabetes insipidus often have an intense and unquenchable thirst.
Increased urine output: The condition causes the body to produce large amounts of urine, often up to several liters per day.
Diluted urine: The urine produced in diabetes insipidus is often very pale and diluted due to the body’s inability to concentrate urine.
Dehydration: Despite the increased thirst, people with diabetes insipidus may still become dehydrated due to the large amount of water lost in their urine.
Dry skin and mucous membranes: The condition can cause dryness of the skin, mouth, and eyes due to dehydration.
Fatigue and weakness: Dehydration can also lead to fatigue and weakness.
Headaches: Some people with diabetes insipidus may experience headaches, particularly if they become dehydrated.
Irritability and confusion: Dehydration and electrolyte imbalances caused by diabetes insipidus can sometimes lead to irritability and confusion.
Leads to polydipsia and polyuria
Can also be caused by lithium (used to treat bipolar) and other nephrogenic causes
Gian cell (Granulomatous) arteritis signs and symptoms
jaw px fatigue or discomfort during chewing or speaking
pain relief on discontinuation of jaw movement
sever temporal head aches
scalp tenderness
unexplained fever
visual impairment
Headache
Tenderness of scalp
Polymyalgia syndrome
Visual disturbance
Intermittent claudication of jaw and tongue on mastication
Tender vessels
Rheumatoid Arthritis signs and symptoms
Early morning stiffness lasting more than 30 minutes
Insidious onset (often what distinguishes inflammatory from mechanical)
Pain improves with exercise but not at rest
SI joint pain usually presenting as tenderness over alternating buttocks
Night pain
Back pain lasting more than 3 months, which can be intermittent
Sjogren’s Syndrome signs and symptoms
Dry mouth and lips
Erythema of the tongue and mucosa
Dry eyes, conjunctivitis and irregularity of the corneal light reflex
Salivary gland enlargement and dysfunction
Difficulty chewing and swallowing
Associated conditions (RA, SLE)
Juvenile Idiopathic Arthritis (JIA) signs and symptoms
Signs & Symptoms
Arthritis present for at least 6 weeks – mandatory for the diagnosis of JVA / JIA.
Insidious or abrupt onset
Morning stiffness
Arthralgia during the day
Child complains of joint pain, or uses joints abnormally
History of school absence and / or not wanting to participate in PE
Fevers which occurs 1-2x a day at roughly the same time
May have psoriasis or a subtle dermatological manifestation
Psoriatic Arthritis signs and symptoms
1 in 5 patients with psoriasis have psoriatic arthritis
Findings on exam:
Enthesopathy or enthesitis – Achilles & plantar Fascia
Dactylitis
Skin lesions – scaly silvery plaques
Nail Lesions – Beau’s lines, leukonychia, onycholosis, subungual hyperkeratinosis etc.
Synovitis
Gout signs and symptoms
Presentation
“Gouty attacks”
80% initially monoarticular
Over long periods, become polyarticular
Intense pain over affects joint
Initial attacks 1st metatarsophalangeal joint (podagra)
May be accompanied by fever, chills & malaise.
Long term gout – uncontrolled hyperuricemia (chronic arthritis & tophi)
Calcium Pyrophosphate Deposition (CPPD) aka Psuedogout signs and symptoms
Asymptomatic CPPD
Radiographic Findings
Acute attacks
Acute monoarticular or oligoarticular arthritis
Similar presentation to acute gout attack
(Warmth, intense pain, swelling, etc)
50% of the time knee
Chronic arthropathy
Multiple joints, upper and lower extremity
Severe joint degeneration in some cases
Ankylosing Spondylitis signs and symptoms
Presentation
Inflammatory Back pain
Dull, poorly localized low back / SIJ / gluteal region.
Usually begins unilaterally & is intermittent which becomes bilateral and more persistent as it progresses.
Morning stiffness lasting at least 30 mins- pain can wake them in the early morning / night pain.
Enthesitis
Achilles Tendon insertion
Plantar fascia on calcaneus
Base of 5th Metatersal head
Iliac crest
Superior / inferior poles of patella.
And others!
Gradual reduction in spinal range of motion
Eventual progression of fusion of vertebral bodies “bamboo spine”
Early Stages – sacroiliitis
Stooped flexed posture
Back Pain
Unilateral / alternative gluteal pain
Peripheral involvement
Enthesitis
Dactylitis
Loss of chest expansion (late stage of disease)
Responds well to anti- inflammatory medication
+ / - extra- articular symptoms
Acute presentation
Unilateral painful red eye with
photophobia,
Increased lacrimation
Blurred vision
CV involvement
Rare, and if seen – is present in those with severe long standing AS
Aortitis
Ascending aorta affected
Leads to aortic valve insufficiency
May also lead to various degrees of AV block
Pulmonary
Late stage AS
Costovertebral & costosternal involvement limited chest expansion
Neurological Complications
Secondary to fractures of a fused bamboo spine.
Can be difficult to diagnose on X-Ray
Long standing AS has increased risk of osteoporosis which further increases risk of Fx.
NB- patients presenting with acute exacerbations of neck / back pain who has severe advanced AS should be evaluated for Fx – CT / MRI would be advised.
Cervical Myelopathy
Due to being prone to atlantoaxial subluxation
Cauda Equina
GI Involvement
60% of AS patients appear to have inflammation of colon (proximal) and terminal ileum.
Reactive Arthritis / Reiter’s Syndrome signs and symptoms
Presentation
Classic Triad
Urethritis
Arthritis
Conjunctivitis
Low Back Pain
Asymmetrical (usually lower limb) oligoarthritis / joint stiffness / dactylitis
Fever / malaise / fatigue.
Systemic Lupus Erythematosus signs and symptoms
Presentation
Highly varied
Childhood:
Malar Rash
Seizures
Ulcers
Kidney involvement – proteinurea
Thrombocytopenia
Fever
Lymphadenopathy
Hyemolytic anemia
Presentation
Fever, Joint Pain & Rash in a Female of childbearing age Prompts investigation for SLE
The following may be present:
MSK – arthralgia, myalgia, arthopathy
Dermatological- malar rash, photosensitivity, discoid lupus
Renal – S&S of acute or chronic kidney failure, acute nephritic disease
Pulmonary – Pleurisy, pleural effustion, pulmonary hypertension
GI- Nausea, abdominal pain, dyspepsia,
CV - Pericarditis, myocarditis
Hematologic- leukopenia, lymphopenia, anemia, thrombocytopenia
Polymyositis signs and symptoms
Affects muscles around the head, neck, shoulders, back & hips.
Symptoms:
Muscle weakness
Aching / painful muscles
Fatigue
Difficulty sitting or standing up, combing hair, picking up a cup.
Swallowing issues
Findings it difficult to hold your head up
Feeling down / depressed
Dermatomyositis signs and symptoms
Same symptoms as polymyositis, but present is also a distinctive rash.
Rash develops before muscle symptoms start
Rash is:
Red / purple or dark
Usually face – eyelids, nose, cheeks
Hands – around the knuckles.
Rash can be painful or itchy.
Symptoms:
Muscle weakness
Aching / painful muscles
Fatigue
Difficulty sitting or standing up, combing hair, picking up a cup.
Swallowing issues
Findings it difficult to hold your head up
Feeling down / depressed
Sjorgen’s signs and symptoms
Presentation
Dry eyes
Dry mouth
Swelling / tenderness of lymph nodes
Fatigue
Dry skin
Joint pain & general achiness
Bowel irritation
Marfan Syndrome signs and symptoms
Skeletal System
Tall, thin individuals
Pectus carinatum / excavatum
Increased arm span to height ratio (greater than 1.05)
Positive wrist sign
Positive Steinberg sign
Thoracolumbar scolisis more than 20degrees
Protrusio acetabuli (on AP pelvis)
Joint hypermobility
Facial appearance characteristics enopthalmos, down slanting palpebral fissure, terognathia
Optic Involvement
Lens dislocation aka ectopia lentis
Abnormally flat cornea
Myopia caused by hypoplastic iris or ciliary muscle
Pulmonary Involvement
Sponatenous pneumothorax
Apical blebs
Cardiovascular Involvement
Dilated ascending aorta +/ - regurgitation
Dissection of ascending aorta
Mitral valve prolapse +/ - regurgitation
Dilated pulmonary artery
Calcification of mitral valve anulus
Dilation or dissection of descending thoracic aorta or abdominal aorta
Ehler’s Danlos Syndromes (EDS) signs and symptoms
most common across all types are:
Joint Hypermobility
Skin hyperextensibility
Tissue fragility
Localised Scleroderma signs and symptoms
Localised Scleroderma
Usually only affects the skin, but can affects musces, joints.
Does not affect internal organs.
Symptoms:
Disoloured patches (morphea)
Streak or bands of thick hard skin on arms / legs (called linear scleroderma)
Limited Cutaneous Systemic Sclerosis (CREST syndrome)
signs and symptoms
Skin thickening & tightness usually limited to the fingers & toes
Associated with pulmonary hypertension
C – calcified nodules under the skin
R- Raynauld’s Phenonmenon
E- Esophagus issues – difficulty swallowing, heartburn (extremely common)
S- Skin thickening
T- Tightening or fingers & talengiectasias.
