Endocrine Flashcards
2 common causes of hypercalcemia
primary hyperparathyroidism or cancer
Signs and symptoms of hypercalcemia
polyuria and polydipsia
dyspepsia
depression
Muscle weakness
constipation
vomiting
abdo pain
cardiac arrhythmias
Ix for hypercalcemia and why
- corrected calcium - raised
- PTH
- serum albumin
- U+ E
- ALP ( raised in primary hyperparathyroidism, myeloma or bone metastases )
- LFT
- TFT (thyrotoxicosis)
serum phosphate levels - ECG
Management for non acute hypercalcemia
referral to specialist
Management for acute hypercalcemia
treat underlying causes
maintain a generous oral salt and water intake
bisphosphonate
RF for hyperkalaemia
Male sex
medication (digoxin, potassium sparing diuretics, NSAIDS, ACEi, ARBs, heparin)
CKD
Addison’s disease
Hypertension
SS for severe hyperkalaemia
Paraesthesia
Muscle weakness
Fatigue
Chest pain
SOB
Palpitation
Ix for hyperkalaemia
FBC
U+E
Creatinine
ECG
1 Main ECG changes in hyperkalaemia
Tall tented T waves
Management for hyperkalaemia
A-E approach
Stop any contributory drugs
To protect cardiac membrane - give calcium gluconate
To shift potassium into cells - Insulin- glucose IV infusion
to remove potassium from body - calcium resonium with lactulose
causes of Hypernatremia
it represents a deficit of water relative to sodium
Causes :
- Fluid loss without water replacement
- Diabetes insipidus
- Osmotic diuresis
- Cushing’s / conns
SS for hypernatremia
Confusion
Irritability
Lethargy
Polydipsia/ polyuria
Dry mouth
Poor skin turgor
Decreased JVP
Ix for hypernatremia
U+ E
FBC
Urine osmolality
Urine flow rate
Management for hypernatremia
should be corrected slowly over a period of 48 hours - IV fluids
what 2 things control calcium levels
parathyroid hormone and vitamin D
some acquired causes of hypocalcaemia
hepatic diseases
kidney diseases
vit D deficiency
Hypomagnesaemia
diet
medication
surgery
SS for hypocalcaemia (CATS)
Convulsion /muscle cramps
Arrhythmias
Tetany or tingling
Stridor or spasms
Examination findings in hypocalcaemia
Chvostek’s signs
Trousseau’s signs
Ix for hypocalcaemia
FBC, U+E
Vit D
ECG
Management for Hypocalcaemia
Treat where symptomatic
calcium gluconate
oral calcium preparation
calcitriol if renal impairment present
what is hypoglycaemia defined as
blood sugar less than 3.5 mmol/L
SS for hypoglycaemia
headache
coma and seizures (severe case)
aggression and confusion
Palpitation
hunger
sweating
visible tremor
tachycardia
Management for hypoglycaemia
if conscious :simple carbohydrate
if unable to take it orally then ; IM glucagon
then give long acting carbohydrate once level above 4 mmol/litre
RF for hyponatraemia
older age
hospitalisation
comorbidities
medication
ss for hyponatraemia
confusion
headache
balance difficulties
low urine output
N/V
Seizures
Coma
Management for hyponatraemia
treat underlying problem if present
stop any contributing medicines
which thyroid hormone is more abundant in blood
T4
Which thyroid hormone is more potent
T3
What is the levels in primary hypothyroidism
High TSH and low T4
what is the levels in secondary hypothyroidism
TSH levels may be low or normal but T4 is below range
SS of hypothyroidism
Fatigue
cold intolerance
Weight gain
constipation
non specific weakness
menstrual irregularities
depression
dry skin and hair loss
Management for hypothyroidism
levothyroxine
RF for diabetes types 2
- FHx
- Poor diet
- Lack of exercise
- Obesity
- Ethnicity
- Hx of gestational diabtes
- pcos
SS for type 2 diabetes
- Polydipsia
- Polyuria
- Blurred vision
- Unexplained weight loss
- tiredness
- acanthosis nigricans
Ix and diagnostic result for type 1 diabtes
random blood glucose = 11.1
fasting = 7
HbA1C= 48
Management for type 2 diabetes
Lifestyle advice
DESMOND
Screen for complication
1)Metformin - first line
2)dual therapy - metformin +gliptin/pioglitazone/ sulfonylurea/SGLT2-inhibitor
3) Triple therapy
what is Addison’s disease
occurs when there is a destruction of adrenal cortex leading to reduction of glucocorticoid production
primary causes of Addison disease
autoimmune
trauma
infection like TB
Secondary causes of Addison’s disease
Congenital
base of skull fracture
neoplasm
CRH deficiency
SS of Addison’s disease
Hypotension
Fatigue and weakness
Gi symptoms
Syncope
Pigmentation
diagnostic test for Addison’s disease
short synacthen test
FBC results in addisons
- Low sodium
- High potassium
- Low glucose
- Low cortisol
- ACTH: High in primary insufficiency, low/low normal in secondary insufficiency
- Renin (high in Addisons)
- Aldosterone (low in Addisons)
Management for addisons
Hydrocortisone
if pt has postural hypotension’s what med do u give to manage addisons
Fludrocortisone
3 main actions of PTH
- Increases bone resorption → can lead to increases calcium levels in the extracellular fluids
- Increased reabsorption in the kidney → increases amount of calcium absorbed from loop of Henle and distal tubules. Also it increases the rate of phosphate excretion.
- Vitamin D synthesis → stimulates formation of vit D which increases calcium absorption from the gut.
layers of the adrenal gland (outer to inner)
-adrenal cotrex comprised off:
zonal glomerulosa
Zona fasciculata
Zona reticularis
-Adrenal medulla
Function of adrenal medulla
Mainly responsible for synthesis of adrenaline and NA
also involved in dopamine production
Function of zona reticularis
Site of biosynthesis of androgen precursors such as DHEA and androstenedione
Responsible for sexual characteristics development during puberty.
Hypothalamus secrete CRH which bind to ant. Pituitary gland which secretes ACTH
Zona fasciculata function
Thickest part
Secrete cortisol and corticosterone→ these hormone regulate carbohydrate metabolism when an individual is in a time of stress
Zona glomerulosa function
synthesise mineralocorticoid hormones→ plays an important role in the maintenance of electrolyte and water balance in the body.
E.g. Aldosterone
what is acromegaly
Acromegaly is a condition resulting from excessive growth hormone secretion, usually due to a secreting pituitary adenoma
Diff between acromegaly and gigantism
Acromegaly: after closure of the epiphyses
Gigantism: occurs before closure of the epiphyses
SS of acromegaly
-Large hands and feet
- Outward growth of the jaw and head with increased inter dental spacing and macroglossia
- Headaches
- Erectile dysfunction
- Voice change
- Increased sweating
- Mood disturbances
- Fatigue.
Ix for acromegaly
OGTT and growth hormone measurement
MRI/CT pituatry
Management for acromegaly
Surgery
Radiation
Somatostatin analogues
What is cushing’s syndrome
excess glucocorticoid and loss of normal aafeedback loop
ss of cushings syndrome
striae
bruising
moon face
obesity
hypertension
thin skin
management for cushings disease
- Cushing’s Disease
- surgical removal of pituitary adenoma +/- bilateral adrenalectomy, radiotherapy
- Adrenal Adenoma
- unilateral adrenalectomy
- Adrenal Carcinoma
- Adrenalectomy, radiotherapy, chemotherapy
- Ectopic ACTH
- Surgical removal if tumour located, radiotherapy, chemotherapy
- Ketoconazole (high doses) blocks steroid synthesis
what is conns syndrome
hyper aldosteronism
usually caused by an adrenal adenoma
SS of conns syndrome
- Often asymptomatic
- Hypokalemia – Muscular weakness, fatigue, headache
- Hypernatraemia → volume retention → Hypertension (not always present)
- Polyuria and polydipsia - reduced ability of the kidneys to concentrate urine
Management for conns
Surgery
Spironolactone
what is diabetes insipidus
Diabetes Insipidus (DI) is a disorder caused by hyposecretion or insensitivity to ADH which leads to polydipsia, polyuria and large amounts of dilute urine.
SS of diabetes insipidus
- Polyuria (dilute urine)
- Polydipsia
- Dehydration
what is galactorrhoea
Production of breast milk when not pregnant
RF for galactorrhoea
Prolactinoma, hypothyroidism, Cushing’s, acromegaly, medication that ↑ prolactin
what is gynaecomastia
abnormal breast tissue in men
what is graves disease
hyperthyroidism
primary hyperthyroidism levels
Primary- low TSH and high Thyroxine
hyperthyroidism ss
Rapid onset malaise
fever
Breathlessness, hoarse voice, dysphagia
palpitation
diarrhoea
Fatigue
exercise intolerance
Heat intolerance
Management for hyperthyroidism
Refer to an endocrinoligsits
give beta blocker (propanalol)
anti-thyroid drugs: carbimazole and propylthiouracil
Radioactive iodine treatment- first lline for graves disease
Thyroid surgery
Pathophy of hyperparathyroidism
Primary:
- one or more parathyroid gland produces excess PTH
Secondary:
- increased secretion of PTH in response to low calcium because of kidney, liver, or bowel disease
Tertiary:
- There is a autonomous secretion of PTH, usually because of chronic kidney disease
features of hypercalcemia
Painful bones
Renal stones
Abdominal groans (pain)
Psychiatric moans (depression, confusion, lethargy)
what is phaeochromocytoma
catecholamine secreting tumour
SS of phaeochromocytoma
Episodic HTN, anxiety, tachycardia, headache, sweating, tremor
who is thyroid storm most likely to occur inn
it may occur in people with undiagnosed hyperthyroidism or in people who abruptly stopped the medication
SS of thyroid storm
fever, tachycardia, agitation, hyperthermia, hypertension, atrial fibrillation, heart failure, jaundice, delirium, and coma
Management for thyroid storm
- Symptom control:
- IV propranolol
- Reduce thyroid activity
- Propylthiouracil
- Lugol’s iodine 4 hours later
- carbimazole is second line
- IV hydrocortisoneto reduce thyroid inflammation
what is thyroiditis
inflammation not an infection
types of thyroiditis
Hashimoto’s
de qurevians
post partum
graves disease
toxic multinodular
Management for thyroiditis
Aspirin, bedrest, +/- steroids
Thyroid neoplastic disease SS
- Enlarging thyroid nodule (painless), hoarseness, difficulty swallowing
- “Cold Nodule” on scan
What is type 1 diabetes
autoimmune condition in which the immune system targets and destroys the insulin-producing cells of the pancreas
SS of type 1 diabetes
Polyuria
Polydipsia
Weight loss
DKA
